Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献_第5页

Patient With Leukocytosis and Persistent Dry Cough 白细胞增多伴持续性干咳患者

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 DOI: 10.12788/fp.0407

Mariela M Rivera-Agosto

{"title":"Patient With Leukocytosis and Persistent Dry Cough","authors":"Mariela M Rivera-Agosto","doi":"10.12788/fp.0407","DOIUrl":"https://doi.org/10.12788/fp.0407","url":null,"abstract":"An 83-year-old man who was a nonsmoker with no history of systemic disease was transferred to the Veterans Affairs Caribbean Healthcare System from an outside hospital due to marked leukocytosis (white blood cell [WBC] count, 22.5 × 10/μL). He reported a 3-month history of persistent dry cough, which required several primary care physician (PCP) evaluations. He was initially treated for an upper respiratory tract infection without adequate response. Instead, his symptoms progressed, and he presented with associated hoarseness and unintentional 26-pound weight loss. The patient’s physical examination was remarkable for left-sided decreased breath sounds. Laboratory tests confirmed leukocytosis (WBC, 20.0 × 10/μL), and his radiographic chest X-ray (Figure 1) showed a left upper lobe mass, confirmed by computed tomography (CT) (Figure 2) in which mediastinal lymphadenopathy also was seen. The abdominal/pelvic CT showed renal and bilateral adrenal lesions suggestive of metastatic disease. A core needle biopsy from the anterior component of the mediastinal mass showed pleomorphic cells with hyperchromatic nuclei, spindle configuration, and mitotic figures (Figure 3). Immunohistochemistry was positive for pancytokeratin, CK7, and vimentin.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135640630","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}

引用次数: 0

Idiopathic Granulomatous Lobular Mastitis: A Mimicker of Inflammatory Breast Cancer 特发性肉芽肿性小叶性乳腺炎:炎性乳腺癌的模拟物

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 DOI: 10.12788/fp.0408

Benjamin F Wilson

{"title":"Idiopathic Granulomatous Lobular Mastitis: A Mimicker of Inflammatory Breast Cancer","authors":"Benjamin F Wilson","doi":"10.12788/fp.0408","DOIUrl":"https://doi.org/10.12788/fp.0408","url":null,"abstract":"Background: Idiopathic granulomatous lobular mastitis (IGLM) is a rare, chronic inflammatory breast disease without a known etiology. Even though the current literature proposes several treatment strategies, there is no universal consensus for long-term management. Case Presentation: A 43-year-old White woman (gravida 5, para 4) presented with a 2-week history of right lower outer quadrant breast tenderness, heaviness, warmth, and redness. Mammography and ultrasound were concerning for inflammatory breast cancer. Biopsies returned as granulomatous mastitis without malignancy. After 8 months of unsuccessful therapy with prednisone and methotrexate, surgeons excised the breast tissue. Cultures and special stains were negative for other organisms. At the 7-month follow-up, no evidence of recurrence was seen. Conclusions: As there remains no consensus behind the etiology or management of IGLM, our case demonstrates a reasonable and successful stepwise treatment beginning with medical therapy before proceeding to surgical cure. Because of possible malignancy risk with chronic IGLM, patients should not delay surgical excision if their condition remains refractory to medical therapy alone.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135640738","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}

引用次数: 0

Using Active Surveillance to Identify Monoclonal Antibody Candidates Among COVID-19–Positive Veterans in the Atlanta VA Health Care System 利用主动监测在亚特兰大VA医疗保健系统中识别covid -19阳性退伍军人中的单克隆抗体候选物

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 DOI: 10.12788/fp.0411

Kathryn E DeSilva

{"title":"Using Active Surveillance to Identify Monoclonal Antibody Candidates Among COVID-19–Positive Veterans in the Atlanta VA Health Care System","authors":"Kathryn E DeSilva","doi":"10.12788/fp.0411","DOIUrl":"https://doi.org/10.12788/fp.0411","url":null,"abstract":"an orally admin- istered prodrug of N-hydroxycytidine (NHC, EIDD-1931), a nucleoside with broad antiviral activity against a range of RNA viruses. MOV acts by driving viral error catastrophe following its incorporation by the viral RdRp into the viral genome. Given its mechanism of action, MOV activity should not be affected by substitu- tions in the spike protein present in SARS-CoV-2 variants of concern which impact efficacy of therapeutic neutralizing antibodies and vaccine induced immunity. We characterized MOV activity against variants by assessing antiviral activity in vitro and virologic response from the Phase 2/3 clinical trials (MOVe-In, MOVe-Out) for treatment of COVID-19. Methods. MOV activity against several SARS-CoV-2 variants, was evaluated in an in vitro infection assay. Antiviral potency of NHC (IC50) was determined in Vero E6 cells infected with virus at MOI ~0.1 by monitoring CPE. Longitudinal SARS- CoV-2 RNA viral load measures in participants enrolled in MOVe-In and MOVe-Out were analyzed based on SARS-CoV-2 genotype. Sequences of SARS-CoV-2 from study participants were amplified from nasal swabs by PCR and NGS was performed on samples with viral genome RNA of >22,000","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135640739","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}

引用次数: 0

Supplements Are Not a Synonym for Safe: Suspected Liver Injury From Ashwagandha 补品不是安全的同义词:阿什瓦甘达可能导致肝损伤

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 DOI: 10.12788/fp.0409

Sondra Vazirani

引用次数: 0

Rifampin for Prosthetic Joint Infections: Lessons Learned Over 20 Years at a VA Medical Center 利福平治疗假体关节感染:在退伍军人医疗中心20多年的经验教训

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 DOI: 10.12788/fp.0406

Solana Cushing

{"title":"Rifampin for Prosthetic Joint Infections: Lessons Learned Over 20 Years at a VA Medical Center","authors":"Solana Cushing","doi":"10.12788/fp.0406","DOIUrl":"https://doi.org/10.12788/fp.0406","url":null,"abstract":"Background: The Minneapolis Veterans Affairs Health Care System uses debridement and implant retention (DAIR) combined with oral rifampin and a second antibiotic to treat orthopedic implant infections. However, the success rate of this approach in a veteran population is unknown. Methods: We performed a retrospective analysis of patients who underwent DAIR with a rifampin-containing regimen for an orthopedic implant infection over the past 20 years at the Minneapolis Veterans Affairs Health Care System. The primary outcome was treatment success among participants who were treated with curative intent, defined as planned device retention without ongoing antibiotic use. Secondary outcomes were treatment harms and therapy duration. Treatment success was defined as the absence of recurrent infection or further measures to suppress infection within 1 year of completing antimicrobial therapy. Results: A total of 78 patients (88% male) were included (median age, 65.5 years), with 50 treated with curative intent (primary analysis group). Forty-one participants (82%) in the curative intent group experienced treatment success. The success rate was higher among participants whose implant was < 2 months old vs those whose implant was ≥ 2 months old (93% vs 65%, respectively; P = .02). The 28 participants treated without curative intent had more comorbidities, higher rates of chronic infection, and older implants than those treated with curative intent. Conclusions: Veterans with orthopedic implant infections can be successfully treated with DAIR combined with a rifampin-containing antimicrobial regimen. Success is highest for patients with a recent implant. Debridement and implant retention using regimens that include rifampin is an evidence-based strategy for managing patients with infected prosthetic hardware. Here we report that this approach is feasible in a veteran population, especially with recently implanted prosthetic material.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135640741","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}

引用次数: 0

Salute to Service Dogs 向服务犬致敬

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 DOI: 10.12788/fp.0414

Meaghann Weaver

引用次数: 0

Implementation of an Automated Phone Call Distribution System in an Inpatient Pharmacy Setting. 在住院药房实施自动电话呼叫分配系统。

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-09-01 Epub Date: 2023-09-15 DOI: 10.1278/fp.0402

Samaneh Ghassemi, Freddy Tadros, Elizabeth Stone, Joelle Farano

{"title":"Implementation of an Automated Phone Call Distribution System in an Inpatient Pharmacy Setting.","authors":"Samaneh Ghassemi, Freddy Tadros, Elizabeth Stone, Joelle Farano","doi":"10.1278/fp.0402","DOIUrl":"10.1278/fp.0402","url":null,"abstract":"Background: Inpatient pharmacies receive numerous phone calls from health care professionals and patients. This uncaptured workload poses potential staffing concerns for pharmacy administrators as unequal distribution or misdirected calls to the pharmacy team can lead to accountability and patient safety concerns. We aimed to implement and evaluate the effectiveness of an automated call distribution (ACD) system in an inpatient pharmacy setting at a US Department of Veterans Affairs hospital.Observations: A new inpatient pharmacy service phone line extension was implemented at the Edward Hines, Jr. Veterans Affairs Hospital in Illinois. The ACD phone system yielded positive performance metrics, including ≤ 30 seconds mean speed to answer and ≤ 5% abandonment rate in the 12 months after implementation.Conclusions: The ACD phone system is a promising, new application of available technology implemented in a nontraditional setting. The ACD system provides more actionable information and quality metrics data to pharmacy leadership. The implementation of the ACD system has improved accountability, efficiency, work distribution, and the allocation of resources.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338261","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}

引用次数: 0

Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned. 在VHA内实施戒烟远程健康技术：经验教训。

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-08-01 Epub Date: 2023-08-11 DOI: 10.12788/fp.0393

Sara E Golden, Stephanie Unger, Christopher G Slatore

{"title":"Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned.","authors":"Sara E Golden, Stephanie Unger, Christopher G Slatore","doi":"10.12788/fp.0393","DOIUrl":"10.12788/fp.0393","url":null,"abstract":"Background: Health care systems need to reach patients who are smokers and connect them to evidence-based resources that can help them quit. Telehealth, such as an interactive voice response (IVR) system, may be one solution, but there is no roadmap to develop or implement an IVR system within the US Department of Veterans Affairs (VA).Observations: We describe the development and implemention of IVR at the VA Portland Health Care System in Oregon to proactively reach veterans who use tobacco and connect them with cessation resources. We coordinated with local departments to verify the necessary processes and strategies that are important. We recommend several questions to ask the IVR vendor and be prepared to answer before contract finalization. The Patient Engagement, Tracking, and Long-term Support (PETALS) initiative may be an excellent place to start for VA IVR-related questions and can be used for IVR initiation within the VA, but other vendors will be needed for nonresearch purposes. Finally, we describe the process timeline and steps to help potential users.Conclusions: IVR systems, once they are developed and implemented, can be efficient, low-cost, resource-nonintensive solutions that can effectively connect patients with needed health care services. Developing an IVR system within the VA was challenging for our research team. We experienced a large learning curve during implementation and hope that our experience and lessons will help VA personnel in the future.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589000/pdf/fp-40-08-256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695359","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}

引用次数: 0

Spider Bite Wound Care and Review of Traditional and Advanced Treatment Options. 蜘蛛咬伤伤口护理和传统和高级治疗方案的回顾。

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-08-01 Epub Date: 2023-08-13 DOI: 10.12788/fp.0400

David B Brown, Mohamed Tazi Chibi, Raymond V Searles, Nadia Hassani

{"title":"Spider Bite Wound Care and Review of Traditional and Advanced Treatment Options.","authors":"David B Brown, Mohamed Tazi Chibi, Raymond V Searles, Nadia Hassani","doi":"10.12788/fp.0400","DOIUrl":"10.12788/fp.0400","url":null,"abstract":"Background: Approaches to chronic wound care are worlds apart: In developing nations, the care of chronic wounds often involves traditional management with local products (eg, honey, boiled potato peels, aloe vera gel, banana leaves); whereas in developed nations, more expensive and technologically advanced products are available (eg, wound vacuum, saline wound chamber, hyperbaric oxygen therapy, antibacterial foam). The cost for wound care plays a significant role in total health care costs, and that cost is expected to rise dramatically.Case presentation: A healthy, 60-year-old man presented after being bitten by a spider 6 days earlier. He was treated and prescribed clindamycin 300 mg 4 times daily for 14 days. Despite treatment, the wound continued to enlarge, and the patient showed symptoms of septicemia. The patient was admitted to the hospital and remained for 3 days. On discharge the patient was given a prescription for doxycycline 100 mg twice a day for 10 days and instructed to use iodoform gauze to pack the wound during daily dressing changes. However, the gauze was ineffective. The patient's dressing was switched to an antibacterial foam dressing impregnated with gentian violet and methylene blue.Conclusions: There is a disparity in available wound care product availability. Modern products may yield faster healing times with fewer adverse effects than traditional products. Products used by local healers can produce satisfactory results when more modern products are unavailable and at a fraction of the cost.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589002/pdf/fp-40-08-248.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695361","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}

引用次数: 0

Moral Injury: The Spirit's Unseen Wound. 道德伤害：精神的无形创伤。

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-08-01 Epub Date: 2023-08-16 DOI: 10.12788/fp.0405

Cynthia Geppert

引用次数: 0