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

{"title":"Agranulocytosis and Aseptic Meningitis Induced by Sulfamethoxazole-Trimethoprim.","authors":"Alison A Bunnell, Kimberly D P Hammer, Regan R Miller, Olivia A Harris, Logan C Schmaltz, Alexis M Kokett","doi":"10.12788/fp.0527","DOIUrl":"10.12788/fp.0527","url":null,"abstract":"<p><strong>Background: </strong>Sulfamethoxazole-trimethoprim is an antibiotic that can cause rare and potentially life-threatening adverse effects. This case describes an immunocompetent patient who developed acute agranulocytosis complicated with aseptic meningitis after being prescribed sulfamethoxazole-trimethoprim.</p><p><strong>Case presentation: </strong>A healthy 39-year-old male veteran presented to the emergency department with worsening left testicular pain and increased urinary urgency and frequency. The patient was diagnosed with left epididymo-orchitis and prescribed oral sulfamethoxazole-trimethoprim 800-160 mg every 12 hours for 30 days. Two weeks later, the patient returned to the emergency department with fever, headache, chills, and generalized body aches that led to hospitalization. It was discovered that he had not finished the full course of antibiotics due to symptoms resolution and had restarted the medication to finish the course of therapy. The patient was diagnosed with agranulocytosis and aseptic meningitis secondary to sulfamethoxazole-trimethoprim.</p><p><strong>Conclusions: </strong>This case highlights the rare potential for acute agranulocytosis in combination with aseptic meningitis following the use of sulfamethoxazole-trimethoprim in an immunocompetent patient.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 12","pages":"414-417"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319024","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":"Physician Attitudes About Veterans Affairs Video Connect Encounters.","authors":"Marco Proano, Eyerusalem Akpan, Kimberly Reiter, Vimla L Patel, Vishal Vashistha","doi":"10.12788/fp.0538","DOIUrl":"10.12788/fp.0538","url":null,"abstract":"<p><strong>Background: </strong>The US Department of Veterans Affairs (VA) launched the VA Video Connect (VVC) video conferencing platform to connect veterans with VA clinicians in 2018. We assessed practices, concerns, and perceptions toward VVC encounters among physicians within the VA New Mexico Healthcare System (VANMHCS).</p><p><strong>Methods: </strong>Medicine Service Physicians of VANMHCS who had previously completed ≥ 1 VVC encounter were invited to semistructured interviews. Questions were constructed to assess the following domains: overarching views of video telehealth, perceptions of the VVC application, and barriers to the broad implementation of video telehealth. Interviews were assessed using a qualitative, open-coding approach. Themes were constructed both deductively, through direct responses to interview questions, and inductively, by identifying emerging patterns in the data.</p><p><strong>Results: </strong>Of the 64 physicians invited to participate, 13 (20%) were interviewed. Of those interviewed, 9 (69%) were female, 10 (77%) were specialists, 8 (62%) had been practicing for ≥ 10 years, and 7 (54%) completed ≥ 5 VVC visits. Interviews ranged from 10 to 25 minutes. Five themes were observed: (1) VVC software and internet connection issues affected implementation; (2) patient technological literacy affected both veteran and physician comfort with VVC; (3) integration of supportive measures is desired; (4) clinical video telehealth (CVT) services may increasingly enhance access to care; and (5) in-person encounters provided unique advantages over CVT.</p><p><strong>Conclusions: </strong>Physicians believe VVC could lead to improved access to care for veterans facing geographical challenges. Efforts should focus on improving VVC user interface and addressing technological issues, educating veterans/physicians on the use of CVT, and integrating supportive measures for successful VVC encounters.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 12","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319028","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 Year of AI: Learning With Machines to Improve Veteran Health Care.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0543","DOIUrl":"10.12788/fp.0543","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 12","pages":"388-389"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319029","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":"Patient and Support Person Satisfaction Following a Whole Health-Informed Interdisciplinary Pain Team Meeting.","authors":"Rena E Courtney, Tayler Vebares, Maria Stack Hankey, Dora Lendvai, Jennifer C Naylor","doi":"10.12788/fp.0503","DOIUrl":"10.12788/fp.0503","url":null,"abstract":"<p><strong>Background: </strong>About 65% of veterans report chronic pain in the last 3 months. Whole health is a team-based approach to health care that emphasizes proactive and patient-centered care. This mixed-methods study sought to determine the patient and support person experience of meeting simultaneously with a whole health pain interdisciplinary team.</p><p><strong>Methods: </strong>Self-reported satisfaction from a program-specific survey was collected from veterans and support persons at the Salem Veterans Affairs Healthcare System (SVAHCS) following a meeting with an interdisciplinary pain team that included interventional pain, psychology, physical therapy, pharmacy, and nutrition health care professionals.</p><p><strong>Results: </strong>The survey was completed by 32 support persons and 144 veterans. Twenty percent reported dissatisfaction with previous pain care at SVAHCS. The mean overall satisfaction with the pain interdisciplinary team was 9.2 on a 10-point scale, and all respondents reported that they would recommend the experience.</p><p><strong>Conclusions: </strong>Patients meeting simultaneously with all interdisciplinary team pain care members may be an efficient model of pain care with high patient satisfaction for rural veterans who tend to experience significant barriers to care. Future studies of these simultaneous meetings with pain interdisciplinary teams may be warranted.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 12","pages":"402-407"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319026","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":"Pharmacist-Driven Deprescribing to Reduce Anticholinergic Burden in Veterans With Dementia.","authors":"Bailey Deglow, Holly Embree, Jiahui Chen","doi":"10.12788/fp.0539","DOIUrl":"10.12788/fp.0539","url":null,"abstract":"<p><strong>Background: </strong>The American Geriatrics Society Beers Criteria strongly recommends avoiding anticholinergic medications in patients with dementia or cognitive impairment due to the risk of adverse central nervous system effects. In the veteran population, about 35% of patients with dementia are prescribed a medication regimen with a high anticholinergic burden. This article examines the role of pharmacists for reducing anticholinergic burden in veterans with dementia.</p><p><strong>Observations: </strong>Outpatients with dementia or cognitive impairment at the Veterans Affairs Louisville Healthcare System who were prescribed a potentially inappropriate anticholinergic medication as classified by the Beers Criteria were selected using the VIONE (Vital, Important, Optional, Not needed, Every medication has an indication) deprescribing dashboard. Electronic health record medication reviews were completed by a pharmacist. The prescriber and patient's primary care practitioner were advised to perform patient-specific risk-benefit assessments, deprescribe potentially inappropriate anticholinergic medications, and consider safer alternative medications based on the indication.</p><p><strong>Conclusions: </strong>This quality improvement project suggests that with the use of population health management tools and in collaboration with the interdisciplinary team, pharmacists can identify and deprescribe inappropriate anticholinergic medications. Pharmacists can provide evidence-based recommendations to guide risk-benefit discussion and consider safer nonanticholinergic alternatives (both pharmacologic and nonpharmacologic), aiding in anticholinergic deprescribing.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 12","pages":"408-412"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319027","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":"Whipple Disease With Central Nervous System Involvement.","authors":"Phi Tran, Juan Negron-Diaz, Hector Ramirez","doi":"10.12788/fp.0542","DOIUrl":"10.12788/fp.0542","url":null,"abstract":"<p><strong>Background: </strong>Whipple disease is a rare, chronic, and systemic infectious disease caused by the bacterium <i>Tropheryma whipplei.</i> It can be mistaken for numerous other diseases, including seronegative rheumatoid arthritis and tropical sprue, and it is known to occur concurrently with giardiasis. Whipple disease can be fatal if not promptly recognized and treated.</p><p><strong>Case presentation: </strong>A 53-year-old male presented with an 8-month history of persistent diarrhea, memory distortion, visual disturbances, 30-lb weight loss, and intermittent bilateral hand and knee arthralgias. An autoimmune evaluation for arthralgia was negative. Polymerase chain reaction testing of duodenal biopsy tissue and cerebrospinal fluid was positive for <i>Tropheryma whipplei</i>.</p><p><strong>Conclusions: </strong>Whipple disease should be considered in the differential diagnosis when patients present with chronic seronegative arthritis, gastrointestinal abnormalities, and cognitive changes. This case, along with others reported in the literature, point to the importance of additional testing for Whipple disease, even when a concurrent infection, such as giardiasis, has been identified.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 12","pages":"418-421"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319030","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":"What Primary Care Clinicians Need to Know About Once-Weekly Insulins.","authors":"Jay H Shubrook","doi":"10.12788/fp.0536","DOIUrl":"10.12788/fp.0536","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S47-S52"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018864","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 Impact of a Metformin Recall on Patient Hemoglobin A1c Levels at a VA Network.","authors":"Beth D Greck, Aimee Pehrson, Hayden Spence","doi":"10.12788/fp.0523","DOIUrl":"10.12788/fp.0523","url":null,"abstract":"<p><strong>Background: </strong>In May 2020, the US Food and Drug Administration (FDA) asked 5 pharmaceutical companies to voluntarily recall some formulations of metformin due to contamination. This observational study sought to provide insight changes in hemoglobin A_1c (HbA_1c) levels when veterans switched to alternative antihyperglycemic agents following the recall.</p><p><strong>Methods: </strong>This study included veterans aged ≥ 18 years with type 2 diabetes who were receiving health care from Veterans Integrated Service Network 6 and had an active metformin sustained-action (SA) prescription as of June 1, 2020. This observational study used a complex random-effects within-between model to evaluate the impact that the recall had on HbA_1c levels as patients transitioned from metformin SA to an alternative antihyperglycemic agent (dipeptidyl-peptidase-4 inhibitor; glitazone; glucagon-like peptide-1 [GLP-1] agonist; sodium-glucose cotransporter-2 [SGLT-2] inhibitor; long-acting, rapid-acting, and mixed insulin formulations; immediate-release metformin, or sulfonylurea). This model identified individual-level (within patient) changes and changes between groups of patients that occurred during the year following the recall.</p><p><strong>Results: </strong>A total of 9130 veterans were included. GLP-1 agonists were associated with a substantial decrease in HbA_1c levels for patients and a moderate increase between patients (<i>P</i> < .001). SGLT-2 inhibitors were associated with a notable decrease in HbA_1c levels for patients (<i>P</i> < .001). Insulin use was associated with increased HbA_1c levels, but only between patients. Long-acting insulin and mixed insulin demonstrated marked increases between patients (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>This study demonstrated that following an FDA recall, newer diabetes medications lowered HbA_1c levels compared with metformin SA. Additional registry research is needed to examine HbA_1c trends over time as related to medication therapy and determine long-term complications within the registry population.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 5","pages":"S6-S11"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018847","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":"Satisfaction With Department of Veterans Affairs Prosthetics and Support Services as Reported by Women and Men Veterans.","authors":"Chelsea Leonard, Rachael R Kenney, Joshva Silvasstar, Sheana Bull, Michael Ho, Eric Campbell","doi":"10.12788/fp.0526","DOIUrl":"10.12788/fp.0526","url":null,"abstract":"<p><strong>Background: </strong>Women veterans represent a growing number of veterans with limb loss who receive Veterans Health Administration treatment. This study surveyed a large sample of veterans about their satisfaction with prosthetic-related care and sought to understand how women veterans with limb loss rate their satisfaction with prostheses and care.</p><p><strong>Methods: </strong>We conducted a cross-sectional, mixed-mode survey of 46,614 veterans with major upper or lower limb amputation or partial foot amputation to assess amputation type, prosthesis use intensity, satisfaction with prostheses and services, and quality of life. We conducted a descriptive analysis and compared responses for individuals who self-identified as men and women. χ² tests determined significant differences in percentage calculations and <i>t</i> tests determined significant differences in means across gender.</p><p><strong>Results: </strong>A total of 4981 respondents completed the survey, yielding a 10.7% raw response rate. Most respondents identified as men (83%) and White (77%). The mean age for men was 67 years while the mean age for women was 58 years. Women respondents were less likely to have diabetes or report their most recent amputation resulting from diabetes. Women were more likely to report not using a prosthesis, to use prostheses less intensely, and to have lower overall satisfaction, including lower satisfaction with prosthesis appearance, usefulness, reliability, and comfort. Men were more likely to be satisfied with prosthesis training and problem discussion. There were no differences in quality of life rating between women and men.</p><p><strong>Conclusions: </strong>The findings of this study reflect previous research indicating that women tend to be less satisfied with prostheses. The results also support recent findings that women veterans have different needs regarding prosthesis design and related care. This study is the largest sample of surveyed veterans with limb loss to date. Though the findings suggest veterans are generally happy with prosthetic related services, they point to several areas where their experiences with services or prostheses can be improved.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 11","pages":"358-364"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017562","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":"Multidisciplinary Amputation Prevention at the DeBakey VA Hospital: Our First Decade.","authors":"Neal R Barshes, Aimee D Garcia, Cezarina Mindru, Maria Rodriguez-Barradas, Panos Kougias, David M Green, Samir S Awad","doi":"10.12788/fp0519","DOIUrl":"10.12788/fp0519","url":null,"abstract":"<p><strong>Background: </strong>In 2011, the Veterans Health Administration (VHA) undertook multidisciplinary efforts to improve care for patients with nonhealing foot ulcers and reduce leg amputation rates. This article examines the impact of interdisciplinary care for amputation prevention in the VHA.</p><p><strong>Methods: </strong>The VHA patient population was characterized using internal registries. Texas hospital admission data were used to identify sex and zip-code matched cohorts. VHA provided data on national and local frequencies of various amputations and the number of patients with diabetes.</p><p><strong>Results: </strong>Compared to matched nonveteran patients, veterans treated at VHA hospitals were older and more often self-identified as Black. They also had significantly higher rates of diabetes, chronic kidney disease, and systolic heart failure. A decrease from 160 to 66 amputations per 100,000 was seen from 2012 to 2017 (a 60% reduction) after implementing interdisciplinary care. Several evidence-directed practices were implemented during the study period. The proportion of angiograms for foot ulcers or gangrene increased from 28.9% to 90.9%.</p><p><strong>Conclusions: </strong>Interdisciplinary care can significantly reduce leg amputation rates. This reduction does not seem dependent on a particular model for providing inpatient care.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 5","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018845","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}