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

{"title":"Paclitaxel Drug-Drug Interactions in the Military Health System.","authors":"Thu-Lan T Luong, Karen J Shou, Brian J Reinhardt, Oskar F Kigelman, Kimberly M Greenfield","doi":"10.12788/fp.0499","DOIUrl":"https://doi.org/10.12788/fp.0499","url":null,"abstract":"<p><strong>Background: </strong>Paclitaxel is an antineoplastic agent used to treat breast, lung, endometrial, cervical, pancreatic, sarcoma, and thymoma cancer. However, drugs that induce, inhibit, or are substrates of cytochrome P450 (CYP) isoenzymes 2C8 or 3A4 may alter the metabolism of paclitaxel, potentially impacting its effectiveness. The purposes of this study are to provide an overview of paclitaxel use, identify potential drugs that interact with paclitaxel, and describe their clinical manifestations.</p><p><strong>Methods: </strong>A retrospective analysis was performed on patients receiving paclitaxel to evaluate types and stages of cancer, treatment regimens, and adverse events of paclitaxel alone or paclitaxel in combination with other antineoplastic drugs, using data retrieved in March 2022 from the US Department of Defense Cancer Registry. Additionally, the study compared the health issues and prescriptions of patients who completed treatment with those who discontinued treatment. It evaluated interactions of paclitaxel with noncancer drugs, particularly antidepressants metabolizing and inhibiting CYP3A4, using data from the Comprehensive Ambulatory/Professional Encounter Record and the Pharmacy Data Transaction Service database. Data were retrieved in October 2022.</p><p><strong>Results: </strong>Of 702 patients prescribed paclitaxel, 338 completed treatment. Paclitaxel discontinuation alone vs concomitantly (<i>P</i> < .001) and 1 drug vs combination (<i>P</i> < .001) both were statistically significant. Patients who took paclitaxel concomitantly with a greater number of prescription drugs had a higher rate of treatment discontinuation than those who received fewer medications. Patients in the completed group received 9 to 56 prescription drugs, and those in the discontinued group were prescribed 6 to 70. Those who discontinued treatment had more diagnosed medical issues than those who completed treatment.</p><p><strong>Conclusions: </strong>The study provides a comprehensive overview of paclitaxel usage from 1996 through 2022 and highlights potential drug interactions that may affect treatment outcomes. While the impact of prescription drugs on paclitaxel discontinuation is uncertain, paclitaxel and antidepressants do not have significant drug-drug interactions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S70-S82"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484092","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":"Anti-Tumor Necrosis Factor Treatment for Glomerulopathy: Case Report and Review of Literature.","authors":"Olcay Y Jones, Laura C Malone, Celina Brunson","doi":"10.12788/fp.0506","DOIUrl":"https://doi.org/10.12788/fp.0506","url":null,"abstract":"<p><strong>Background: </strong>Glomerulopathy involves damage to the glomerular filtration barrier for several reasons, resulting in idiopathic nephrotic syndrome (NS). Treatment options are limited and often include steroids with varying levels of response.</p><p><strong>Case presentation: </strong>A 7-year-old male with a history of NS at age 2 years that developed following a respiratory tract infection was found to have a heterozygous variant of uncertain significance in <i>COL4A4</i> and <i>TRPC6</i> genes. Biopsy findings included podocytopathy and changes in the basement membrane. Upon initial response to steroids, the patient was treated with a brief course of anakinra followed by adalimumab for > 2 years as steroid-sparing biological response modifiers. After a gradual taper, the patient remains in remission and has not received treatment in the last 12 months.</p><p><strong>Conclusions: </strong>This case shows the complex nature of biologically predetermined cascading events in the emergence of glomerular disease with environmental triggers and genetic factors. Downregulation of somatic tissue-driven proinflammatory milieu originating from the constituents of the glomerular microenvironment can help in recovery from emerging podocytopathy. Blocking tumor necrosis factor-α early in the disease course, even temporarily, may allow time for the de novo regenerative process to prevail. Additional research is warranted to test this hypothesis and minimize steroid use.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 8","pages":"250-255"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486002","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":"I*DEA in the VA: Optimizing the Physician Workforce to Enhance Quality of Care.","authors":"Avilasha Sinha, Srey Ram Kuy, Preeti R John","doi":"10.12788/fp.0492","DOIUrl":"https://doi.org/10.12788/fp.0492","url":null,"abstract":"<p><strong>Background: </strong>The demographic characteristics of veterans has changed significantly in recent years and continues to become more diverse. To enhance the quality of health care for the current community of enrolled veterans, it is critical that the physicians and health care leaders of the Veterans Health Administration (VHA) understand the changing demographics and health care needs of the veteran population.</p><p><strong>Observations: </strong>Studies have shown that increased inclusion, diversity, and equity among clinicians are associated with improved clinical outcomes. Diversity encompasses more than race and gender. Although the VHA workforce is relatively diverse, the same cannot be said about its leadership. The I*DEA (inclusion, diversity, equity, and access) Council is a new program that aims to eliminate gaps in VHA care and benefits to ensure that historically underserved veteran communities receive fair treatment.</p><p><strong>Conclusions: </strong>Optimizing I*DEA strategies-inclusion of diverse perspectives and ideas, equity of opportunities and accessibility within the VHA workforce-may help to enhance the quality of health care for veterans.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 8","pages":"236-241"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484087","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":"Acquired Factor VIII Deficiency Presenting as Compartment Syndrome.","authors":"Loretta Coady-Fariborzian, Jessica Schmit","doi":"10.12788/fp.0502","DOIUrl":"https://doi.org/10.12788/fp.0502","url":null,"abstract":"<p><strong>Background: </strong>Compartment syndrome of the upper extremity is a surgical emergency that most often presents after an identifiable event, such as a crush injury, a closed fracture, a snake bite, reperfusion after embolectomy, an electrical injury, or a circumferential burn.</p><p><strong>Case presentation: </strong>We report an unusual case in which an older woman was diagnosed with acquired factor VIII deficiency after presenting with acute nontraumatic compartment syndrome in her right upper extremity. Emergency medicine, plastic surgery, internal medicine, hematology, and hand therapy specialists worked together to identify the pathology and successfully treat the patient.</p><p><strong>Conclusions: </strong>An isolated elevated partial thromboplastin time level in a patient who is bleeding should raise suspicions for factor VIII deficiency and immediately trigger further evaluation. Once this diagnosis is suspected, multidisciplinary treatment is indicated for immediate and long-term successful outcomes.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S85-S88"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484088","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":"Using Telehealth to Increase Lung Cancer Screening Referrals for At-Risk Veterans in Rural Communities.","authors":"Sayyed Hamidi, Israel Rubinstein, Tandra Beck","doi":"10.2788/fp.0500","DOIUrl":"https://doi.org/10.2788/fp.0500","url":null,"abstract":"<p><strong>Background: </strong>At-risk rural veterans have low rates of lung cancer screening (LCS). This proof-of-principle quality improvement project aimed to determine whether a telehealth intervention would increase referrals for at-risk veterans living in the rural upper Midwest and attending a smoking cessation program to LCS with low-dose computed tomography (LDCT) of the chest.</p><p><strong>Methods: </strong>Sixty-eight of 74 LCS-eligible rural veterans who self-enrolled in a smoking cessation program were contacted by telephone. Those who agreed to enroll in LCS were referred to LDCT and followed for 4 months. At the conclusion of the intervention, the number of referrals and screenings performed were tabulated. LDCT reports were reviewed and scored according to Lung CT Screening Reporting and Data System (Lung-RADS) version 1.1.</p><p><strong>Results: </strong>Only 3 of 74 LCS-eligible veterans (4%) underwent LDCT before initiation of this telehealth intervention. By the conclusion of this 4-month project, 19 of 74 veterans (26%) underwent LDCT. Forty-one veterans were successfully contacted and 29 agreed to participate in LCS. Of those who agreed to participate, 19 underwent LDCT within 4 months. Of the veterans who received LDCT, 10 were diagnosed with Lung-RADS 1, 7 with Lung-RADS 2, 1 with Lung-RADS 3, and 1 with Lung-RADS 4B. Annual follow-up LDCT or referral for further evaluation were pursued in each case.</p><p><strong>Conclusions: </strong>Collectively, these data suggest that telehealth intervention could increase referrals of at-risk rural veterans to a centralized LCS program at a regional US Department of Veterans Affairs medical facility.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S60-S65"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484094","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":"Prognostication in Hospice Care: Challenges, Opportunities, and the Importance of Functional Status.","authors":"David B Brecher, Heather J Sabol","doi":"10.12788/fp.0498","DOIUrl":"https://doi.org/10.12788/fp.0498","url":null,"abstract":"<p><strong>Background: </strong>Predicting life expectancy and providing an end-of-life diagnosis in hospice is very challenging for most clinicians given their generally poor training for this role and limited medical education. End-of-life diagnosis alone is often used to certify hospice appropriateness. It is essential, however, to document good supporting evidence of decline and comorbidities. Functional status can be a helpful criterion prior to hospice admission and during required 90-day certifications.</p><p><strong>Case presentation: </strong>An 80-year-old male who was diagnosed with Stage IV glioblastoma multiforme was transferred from an acute care hospital to a community living center hospice service for end-of-life care. After 6 months of care, the veteran was able to graduate from hospice and transfer to an adult living facility with minimal care needs.</p><p><strong>Conclusions: </strong>Recognizing the importance of documenting and using functional scales in individuals receiving hospice care is extremely helpful in prognostication.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S50-S53"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484093","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":"Suspected Orbital Compartment Syndrome Leading to Visual Loss After Pterional Craniotomy.","authors":"Niketu Patel, Justin C Cordova, Shikhar H Shah, John Dunford","doi":"10.12788/fp.0493","DOIUrl":"https://doi.org/10.12788/fp.0493","url":null,"abstract":"<p><strong>Background: </strong>Perioperative visual loss is a potentially devastating surgical complication. Its occurrence is exceedingly rare after nonocular surgery, but recent literature has explored several etiologies contributing to its development.</p><p><strong>Case presentation: </strong>We document a case of perioperative visual loss after a pterional craniotomy for the excision of a temporal meningioma in a 47-year-old woman with no significant medical history. The intraoperative course was uneventful, with a myocutaneous flap reflected anteriorly across the orbit. Postoperatively, the patient demonstrated a third cranial nerve palsy and an afferent pupillary defect, with visual loss that persisted > 3 months postsurgery. A diagnosis of central retinal artery occlusion secondary to intraoperative orbital compartment syndrome was considered the likely etiology. However, several alternate diagnoses could not be excluded.</p><p><strong>Conclusions: </strong>Orbital compartment syndrome should be considered in neurosurgical patients presenting with postoperative ophthalmoplegia and central retinal artery occlusion. We recommend a multidisciplinary perioperative approach to reduce the incidence of perioperative visual loss and orbital compartment syndrome in patients undergoing pterional craniotomy.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 7","pages":"209-213"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484084","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":"Use of Hypoglossal Nerve Stimulation for Treating OSA in Military Patient Populations.","authors":"Jessica Alford, Jonathan Vignali, Jacob Collen, Thomas Balkin, Connie Thomas","doi":"10.12788/fp.0480","DOIUrl":"https://doi.org/10.12788/fp.0480","url":null,"abstract":"<p><strong>Background: </strong>Failure to effectively treat obstructive sleep apnea (OSA) and its symptoms is incompatible with military readiness. Continuous positive airway pressure (PAP) is the gold standard treatment for OSA, but it is impractical in austere environments. Another OSA treatment, hypoglossal nerve stimulation (HGNS), which is implanted, could have advantages for military patients but is unclear whether HGNS is efficacious.</p><p><strong>Methods: </strong>We conducted a review of randomized controlled trials and controlled trials published from 2013 to 2023. Primary outcome measures included the Apnea-Hypopnea Index and Epworth Sleepiness Scale. The quality of evidence was assessed using a rating of 1 to 5 based on a modification of the Oxford Centre for Evidence-based Medicine Levels of Evidence and Grades of Recommendation.</p><p><strong>Results: </strong>We identified 334 studies; 318 did not meet inclusion criteria. The remaining 16 articles were classified into 9 cohorts. Six articles were based on data from the STAR trial and 4 were based on data from a German postmarket long-term follow-up of upper airway stimulation for OSA efficacy. The remaining cohorts were smaller studies that examined moderate-to-severe OSA with nonadherence or failure, a randomized controlled crossover trial, and 1 direct comparator with PAP treatment.</p><p><strong>Conclusions: </strong>HGNS feasibility in military settings has not been adequately studied, considering the specific demands of operational settings and patient demographics. Understanding risks and benefits specific to military context will help guide practices and determine the suitability of HGNS for OSA in diverse military settings.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 6","pages":"178-187"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484083","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":"Bridging the Gap Between Inpatient and Outpatient Care.","authors":"Nikhil Seth, George Martinez, Andrew Chapman, Nathan Child, Anika Sikka, Arshad Ghauri","doi":"10.12788/fp.0476","DOIUrl":"https://doi.org/10.12788/fp.0476","url":null,"abstract":"<p><strong>Background: </strong>The Olin E. Teague Veterans' Center (OETVC) is a teaching hospital with a medical ward consisting of 189 beds, 3 teaching teams with 1 resident and 2 to 3 interns, and 3 nonteaching teams. Due to the complexity of hospitalization, there are concerns that patients may not follow up with primary care or fill their prescribed medication and may have postdischarge questions.</p><p><strong>Observations: </strong>A program was created at OETVC to bridge the gap between inpatient and outpatient care. Internal medicine residents call all teaching team patients a week following discharge. They discuss medications, changes in symptoms, follow-up plans, and address all questions. The residents also assist with missed orders and make treatment regimen changes if necessary.</p><p><strong>Conclusions: </strong>This new program has proven to be beneficial. Residents are developing a better understanding of illness scripts and are working on communication skills without time constraints. Patients now have access to a physician following discharge to discuss any concerns with their hospitalization, present condition, and follow-up. Data show a decreased 30-day readmission rate at 6% in the transition of care group compared to 10% in all patients who participated in the program. This program will continue to address barriers to care and adapt to improve the success of care transitions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 6","pages":"188-191"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484081","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 Challenges of Delivering Allergen Immunotherapy in the Military Health System.","authors":"Christopher A Coop, Graey M Wolfley, Brittanie I Neaves","doi":"10.12788/fp.0487","DOIUrl":"https://doi.org/10.12788/fp.0487","url":null,"abstract":"<p><strong>Background: </strong>Many military members suffer from allergic rhinoconjunctivitis, which causes burdensome symptoms such as rhinorrhea, sneezing, nasal congestion, and itchy, watery eyes. These symptoms are not controlled by medications, and many require aeroallergen immunotherapy. However, many patients in the military have difficulty remaining on immunotherapy due to frequent moves, deployments, and temporary duty assignments.</p><p><strong>Case presentation: </strong>A 34-year-old active-duty service member was referred to the Keesler Medical Center allergy clinic with severe allergic rhinoconjunctivitis. His symptoms included rhinorrhea, sneezing, nasal congestion, and itchy, watery eyes, which had been present for several years, occurring seasonally and when exposed to animals. The patient previously received aeroallergen immunotherapy but discontinued the therapy due to frequent military deployments and duty station changes. He restarted immunotherapy and received counseling on aeroallergen avoidance. However, a subsequent military deployment interrupted the continued aeroallergen immunotherapy.</p><p><strong>Conclusions: </strong>The case highlights the difficulty of managing allergy immunotherapy in the military health system due to frequent moves, deployments, and temporary duty assignments. Access to allergists and others trained to administer immunotherapy in deployed settings may help alleviate this challenge to mission readiness.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 6","pages":"192-194"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484082","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}