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

{"title":"Recliner Butt.","authors":"Igor Melnychuk, Cat Graham","doi":"10.12788/fp.0683","DOIUrl":"10.12788/fp.0683","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 4","pages":"149-150"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914651","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":"Ask the Expert Geriatric Psychiatry: A VHA Email Consultation Program to Support Clinicians.","authors":"Brandon C Yarns, Kimberly J Curyto, Ruchi Aggarwal, Gauri Khatkhate, Prasad R Padala, Michele J Karel","doi":"10.12788/fp.0679","DOIUrl":"10.12788/fp.0679","url":null,"abstract":"<p><strong>Background: </strong>About 50% of veterans who receive care from the Veterans Health Administration (VHA) are aged ≥ 65 years and many have complex psychiatric care needs. However, there are insufficient geriatric psychiatrists available to provide care to this population. The VHA has sought to optimize access to specialty geriatric mental health services via virtual consultation services.</p><p><strong>Observations: </strong>The Ask the Expert Geriatric Psychiatry email consultation program was established in June 2021. VHA board-certified geriatric psychiatrists serve as expert consultants and respond to email questions from clinicians regarding the psychiatric care of older adult veterans. A review of 101 questions submitted between February 2022 and December 2023 indicated that the most common questions centered on agitated behaviors, often in the context of dementia or a medical condition. Requests for feedback on the program were sent to 112 consultation requestors, and 30 responded (27% response rate). Of these respondents, 26 (87%) believed the answer they received was very much or extremely helpful, 23 (77%) felt that the answers were prompt, and 27 (90%) were very likely to use the service again.</p><p><strong>Conclusions: </strong>Ask the Expert Geriatric Psychiatry is a low-resource email consultation service that provides rapid feedback to VHA clinicians. Email consultation programs can help meet the needs of populations with limited access to care, such as older adults with cognitive and mental health needs.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl1","pages":"S1-S6"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914609","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":"Seventy-Five Percent of Total Energy Intake Comes From Ultra-Processed Foods Among a Sample of Veterans With Overweight and Obesity: An Exploratory Analysis of Three-Day Food Records.","authors":"Anthony J Basile, Angelina J Roose, Kyle Bolton, Julie Kurtz, Janet Fawcett, Diane J Parrington","doi":"10.12788/fp.0697","DOIUrl":"10.12788/fp.0697","url":null,"abstract":"<p><strong>Background: </strong>About 55% of total energy intake (TEI) comes from ultra-processed foods (UPF) in the United States; however, UPF intake among veterans is unknown. The objective of this study was to quantify UPF consumption in a sample of US veterans.</p><p><strong>Methods: </strong>An analysis was conducted of 3-day food records from 79 veterans with overweight or obesity at the Phoenix Veterans Affairs (VA) Health Care System. Food items were categorized using the NOVA food classification system (minimally processed, culinary processed, processed, and UPF). The percentage of TEI for each group was analyzed using an analysis of variance (α = 0.05).</p><p><strong>Results: </strong>For the 79 veterans sampled, the mean (SD) TEI in 3-day food records was 75% (14%) from UPFs and 14% (12%) from minimally processed foods (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Most TEI of the veterans in this sample was derived from UPFs, which is higher than the US population as a whole. Given the positive relationship between UPFs and various chronic diseases, further efforts to promote diet improvements among veterans is warranted.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 3","pages":"94-98"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922277","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":"Outcomes From the Use of Cefazolin for Surgical Prophylaxis in Patients Allergic to Penicillin.","authors":"Megan Passalacqua, Christopher Knefelkamp, Haylie Lohmar, Kevin Kniery, Carmen Tichindelean","doi":"10.12788/fp.0675","DOIUrl":"10.12788/fp.0675","url":null,"abstract":"<p><strong>Background: </strong>For surgical prophylaxis, alternatives to cefazolin are frequently used in patients with penicillin allergy due to the risk of cross-reactivity. This study investigated whether an evidence-based prescribing tool would result in an increased number of patients with a documented penicillin allergy receiving cefazolin for periprocedural antibiotic prophylaxis without an increase in allergic reactions.</p><p><strong>Methods: </strong>This single-center, retrospective chart review analyzed patients with a documented penicillin allergy who received periprocedural antibiotics between February 1, 2023, and January 31, 2024. The primary objective was to determine the incidence of allergic reactions in patients with a documented penicillin allergy who received cefazolin perioperatively. Secondary outcomes included the appropriateness of antibiotic regimens in congruence with American System of Health Pharmacists (ASHP) recommendations, incidence of surgical site infections (SSIs), incidence of adverse drug reactions in those with a history of anaphylaxis vs nonanaphylaxis allergy, incidence of allergic reactions requiring interventions, and incidence of acute kidney injury (AKI).</p><p><strong>Results: </strong>There were 197 surgical procedures in patients with a documented penicillin allergy. No allergic reactions were reported. In the cefazolin group, 126 antibiotic regimens (99.2%) were in congruence with ASHP recommendations; all regimens were in congruence with ASHP recommendations in the cefazolin plus gentamicin group; and 58 (86.6%) were in congruence with ASHP recommendations in the other antibiotic group. There was no incidence of SSI in the cefazolin or cefazolin plus gentamicin group, and 3 incidents in the other antibiotic group. One instance of AKI was reported in the cefazolin group, and none were reported in cefazolin plus gentamicin or the other antibiotic group.</p><p><strong>Conclusions: </strong>This study reported similar outcomes to previously published research, which supports the perioperative use of cefazolin in patients allergic to penicillin, including those with a history of anaphylaxis.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 3","pages":"100-104"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922280","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 Gap in VA Dental Care is Nothing to Smile About.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0698","DOIUrl":"10.12788/fp.0698","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 3","pages":"92-93"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922258","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":"Thermal Therapy is Associated With Decreased Pain Treatment Use: A Retrospective Cohort Study.","authors":"Travis I Lovejoy, David C Cameron, Robert L Handley, Crystal Lederhos Smith, Sterling M McPherson","doi":"10.12788/fp.0681","DOIUrl":"10.12788/fp.0681","url":null,"abstract":"<p><strong>Background: </strong>Body surface heat and cold (eg, thermal) therapies are nonpharmacologic pain treatments purported to have pain-reducing benefits, but there is limited research on their use for chronic pain. The purpose of this study was to examine the potential clinical and health system benefits of thermal therapy.</p><p><strong>Methods: </strong>Participants included 2182 Veterans Health Administration patients who received a thermal therapy device and 2182 propensity score-matched control patients. Clinical encounters, pain pharmacy data, and pain self-ratings were extracted from the electronic health record in the year prior to and following receipt of a device, or the corresponding dates for matched control patients. Mixed-effects regression and random-effects growth modeling were used to compare changes in pain treatment utilization and pain intensity, between thermal therapy recipients and matched controls.</p><p><strong>Results: </strong>Patients who received thermal therapy had greater reductions in days of high-dose opioid therapy use (Time × Treatment interaction, B = 3.24; 99% CI, 0.34 to 6.14; <i>P</i> < .01) and concurrent use of opioids and benzodiazepines (Time × Treatment interaction, incidence rate ratio [IRR], 0.76; 99% CI, 0.67 to 0.86; <i>P</i> < .01) in the year following device receipt when compared with matched control patients. In addition, patients who received thermal therapy had fewer encounters with pain specialty care, including physical therapy (Time × Treatment interaction, IRR, 1.16; 99% CI, 1.00 to 1.33; <i>P</i> = .01) and pain clinics (Time × Treatment interaction, IRR, 1.49; 99% CI, 1.22 to 1.76; <i>P</i> < .01). Mean pain intensity remained relatively stable for both groups (B = -0.02; 99% CI, -0.06 to 0.02; <i>P</i> = .15).</p><p><strong>Conclusions: </strong>While associations identified in this observational study do not establish causality, thermal therapy may confer health system benefits through decreased use of costly specialty pain care and high-risk opioid use.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 3","pages":"110-117a"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922269","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":"Implementation of a Pharmacist-Led Penicillin Allergy Interview at a Veterans Care Facility.","authors":"James Cole Puckett, Caroline Powers, Maria Shin, Robert Larson","doi":"10.12788/fp.0684","DOIUrl":"10.12788/fp.0684","url":null,"abstract":"<p><strong>Background: </strong>Evaluating a patient's β-lactam allergy involves a thorough review of electronic health records (EHRs), penicillin skin test, and observed oral challenge. The purpose of this study was to evaluate the impact of pharmacist-led penicillin allergy delabeling solely through an interview using the Allergy to β-Lactam Evaluation (ABLE) process.</p><p><strong>Methods: </strong>This single-facility, retrospective cohort study reviewed EHR notes. Patient eligibility for allergy profile modifications was determined using guidance from the ABLE process. Interviews were conducted with patients meeting inclusion criteria. A progress note was entered into the EHR following completion of the interview. Patients were compared to a historical control group and matched for allergy severity (immunoglobulin E [IgE]-mediated allergy, unknown, adverse drug reaction [ADR], and severe cutaneous or other non-IgE-mediated reaction). The primary outcome was the number of patient allergy ADRs that were removed or changed on their profile.</p><p><strong>Results: </strong>Six of 35 patients in the interviewed group had allergy profile modifications. The number of patients with a penicillin allergy/ADR modified regardless of change in their antibiotic regimen was statistically higher in the interviewed group compared with the control group: 6 (17.1%) vs 0 (0%) (<i>P</i> < .03).</p><p><strong>Conclusions: </strong>The study findings support the use of the ABLE process for penicillin allergy/ADR modification or clarification. Although the sample size was small, the ABLE process has the ability to positively impact individuals with inappropriate penicillin allergy documentation in the EHR.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 3","pages":"106-109"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922328","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":"Managing Resistance to Change Along the Journey to High Reliability.","authors":"Col Ret John S Murray, Jonathan Lee, Joan Clifford","doi":"10.12788/fp.0668","DOIUrl":"10.12788/fp.0668","url":null,"abstract":"<p><strong>Background: </strong>Becoming a high reliability organization requires that health care organizations undergo significant safety, quality, and efficiency improvements. Change can be complex and challenging because it often creates instability and discomfort in the workplace. It is imperative that health care organizations understand the sources of resistance to change and recognize strategies to effectively address this challenge.</p><p><strong>Observations: </strong>Understanding the reasons behind resistance to change and developing methods to address the challenge is of great value. This article describes the most common reasons for resistance to change in health care organizations and outlines evidence-based strategies that can be implemented to manage the process.</p><p><strong>Conclusions: </strong>Implementing change in a health care system can be challenging, especially for organizations on the journey to high reliability. Reasons for resistance to change are multifactorial, and recognizing the potential impact these factors may have on organizational change can result in success or failure. Evidence-based strategies can mitigate resistance and assist organizations throughout the change process.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 2","pages":"46-49"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914759","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":"Mental Health Prescribers' Perceptions of Patients With Substance Use Disorders and Harm Reduction Services.","authors":"Nadia Jubran, Kelly Kang, Joy Chai, Alyssia Jaume","doi":"10.12788/fp.0677","DOIUrl":"10.12788/fp.0677","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Health Administration (VHA) has published guidelines outlining the legal authority to operate syringe services programs. To aid in the implementation of harm reduction programs at VHA medical centers in Maryland; Washington, DC; and West Virginia, the perceptions of harm reduction tools by mental health prescribers were evaluated.</p><p><strong>Methods: </strong>A mixed-methods analysis examined mental health prescriber perceptions of patients with substance use disorders (SUDs) and their willingness to provide harm reduction tools. A survey was conducted followed by a voluntary postsurvey interview. A descriptive analysis was performed on responses. Notes from postsurvey interviews were analyzed using the Prosci Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) Model for Change Management.</p><p><strong>Results: </strong>Prescribers felt comfortable and confident in their abilities to educate patients to reduce harm related to substance use. Survey results were mixed regarding comfort in working with people with or without SUDs. Prescribers were represented across the continuum of the ADKAR change model and were more willing to provide naloxone than fentanyl test strips or syringes. Prescribers expressed mixed opinions on the use of harm reduction tools for patients with SUDs. Some prescribers viewed harm reduction as part of a treatment plan, while others viewed a return to drug use as a failure of treatment.</p><p><strong>Conclusions: </strong>This study highlights the need for additional interventions to address clinician hesitancy and concerns surrounding harm reduction tools to successfully implement harm reduction programs across the VHA.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 2","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914838","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":"Median Income and Clinical Outcomes of Hospitalized Persons With COVID-19 at an Urban Veterans Affairs Medical Center.","authors":"Matthew G Tuck, Heather R Rivasplata, Steven A Towers, Angelike P Liappis, Cherinne Arundel, Anca Dinescu, Zachariah Hamidi, Haitham Alaithan, Surabhi Uppal, Pratish C Patel, Shikha Khosla, Samuel J Simmens, Gabriel Durham, Debra A Benator","doi":"10.12788/fp.0678","DOIUrl":"10.12788/fp.0678","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disproportionately affected minorities and individuals of low socioeconomic status (SES) with higher rates of severe illness and death. This disparity has been partly attributed to differences in health care access. This study sought to determine whether place of residence, as a marker of SES, health care access, and income, was predictive of disease severity in a large integrated health care system.</p><p><strong>Methods: </strong>This retrospective cohort study included patients admitted to the Washington Veterans Affairs Medical Center (VAMC) with a COVID-19 diagnosis between March 1, 2020, and June 30, 2021. Patients' income was estimated using 2020 US Census Bureau data on median income by zip code. Univariable and multivariable logistic regression models were used to evaluate associations between receiving high-flow oxygen (HFO), intubation, and death with demographic characteristics, prehospitalization clinical risk factors, and comorbidities. Heat maps were used to visualize the geographic distribution of COVID-19 cases and median income.</p><p><strong>Results: </strong>The cohort included 348 patients with a mean (SD) age of 68.4 (13.9) years; 313 patients (90.2%) were male and 281 (83.4%) were Black. Eighty-six patients (32.8%) required HFO, 33 (10.5%) required intubation, and 57 (16.4%) died. Each $10,000 increase in median income was associated with 10% lower odds of receiving HFO (odds ratio, 0.90; 95% CI, 0.81-1.00). In multivariable models, race and zip code of residence were not associated with the need for HFO, intubation, or death.</p><p><strong>Conclusions: </strong>In a hospitalized population at an urban VAMC, higher median income by zip code was associated with lower odds of needing HFO. However, race and income by zip code residence were not associated with severe COVID-19 outcomes or death. Access to Veterans Health Administration care may mitigate barriers to care that contribute to poorer COVID-19 outcomes among minorities and individuals of low SES.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 2","pages":"76-82"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914862","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}