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

{"title":"A Case of Duodenocaval Fistula in the Setting of Respiratory Failure Initially Confused for Transfusion-Related Acute Lung Injury.","authors":"Gaurav Suryawanshi,&nbsp;Aaron Boothby,&nbsp;Richard Dykowski","doi":"10.12788/fp.0391","DOIUrl":"10.12788/fp.0391","url":null,"abstract":"<p><strong>Background: </strong>A duodenocaval fistula is seen when a connection exists between the duodenum and the inferior vena cava. It is a rare entity that presents a diagnostic challenge due to its nonspecific presenting symptoms and often is found only during a laparotomy or autopsy.</p><p><strong>Case presentation: </strong>A 37-year-old man initially presented to the hospital for melena but went into cardiac arrest before undergoing an esophagogastroduodenoscopy. Unfortunately, a duodenocaval fistula was only found during the autopsy.</p><p><strong>Conclusions: </strong>Duodenocaval fistula is a diagnostic challenge as it may present with nonspecific findings concerning for other etiologies. We want to highlight that although rare, duodenocaval fistula should be considered for patients who present with gastrointestinal bleeding and hypoxic respiratory failure.</p>","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588995/pdf/fp-40-07-228.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695352","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":"COVID-19 Incidence After Emergency Department Visit.","authors":"Jonathan Balakumar,&nbsp;My-Phuong Pham,&nbsp;Selene Mak,&nbsp;Kathleen Yip","doi":"10.12788/fp.0384","DOIUrl":"10.12788/fp.0384","url":null,"abstract":"<p><strong>Background: </strong>The emergency department (ED) at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) saw a decrease in the number of visits during the early stages of the COVID-19 pandemic. Little is known whether risk mitigation procedures may help reduce the spread of COVID-19 infections for veterans visiting the ED. Therefore, we reviewed patient visits to the ED for diagnoses other than COVID-19 to assess whether these patients had an increased COVID-19 positivity rate within 21 days of the initial visit.</p><p><strong>Observations: </strong>Risk mitigation procedures instituted by the VAGLAHS ED included a COVID-19 outdoor testing tent, immediate isolation of persons under investigation for COVID-19, disinfection protocols between high-risk patient encounters, dedicated training in donning and doffing personal protective equipment, implementation of 2-physician airway teams for COVID-19 intubations, use of electronic tablets to communicate with COVID-19 patients, and implementation of social distancing initiatives in the waiting room to minimize COVID-19 exposures. The average positivity rate at the VAGLAHS ED during this time frame was 0% to 6.7%, compared with 6.9% to 33.3% within the wider VAGLAHS.</p><p><strong>Conclusions: </strong>Implementing risk mitigation procedures in the VAGLAHS ED helped minimize exposure and subsequent diagnosis of COVID-19 for veterans who visited the VAGLAHS ED for symptoms not associated with COVID-19 infection. Seeking acute medical care in the ED did not put patients at higher risk of contracting COVID-19.</p>","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588997/pdf/fp-40-07-224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695354","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":"Transition to Tenecteplase From t-PA for Acute Ischemic Stroke at Walter Reed National Military Medical Center","authors":"Cole P Denkensohn","doi":"10.12788/fp.0351","DOIUrl":"https://doi.org/10.12788/fp.0351","url":null,"abstract":"Background: Tissue plasminogen activator (t-PA) has been the standard IV thrombolytic drug used in acute ischemic stroke treatment since 1995. Tenecteplase has been available for use in acute myocardial infarction and has been endorsed by the American Heart Association stroke guidelines as an alternative to t-PA. Observations: A systematic process to safely transition from t-PA to tenecteplase for acute ischemic stroke was undertaken at Walter Reed National Military Medical Center. The process to implement tenecteplase required extensive training and education for staff physicians, nurses, pharmacists, radiologists, trainees, and the rapid response team. There are a variety of benefits and implementation challenges to consider when transitioning thrombolytic therapy for institutional use in acute ischemic stroke. Conclusions: Evidence supports the transition from t-PA to tenecteplase for acute ischemic stroke. Successful transition required months of preparation involving multidisciplinary meetings that included neurology, nursing, pharmacy, radiology, rapid response teams, critical care, and emergency medicine. Safeguards must be implemented to avoid dosing errors that can lead to life-threatening adverse events.","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91144935","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":"Assessment of IV Edaravone Use in the Management of Amyotrophic Lateral Sclerosis","authors":"Christopher Damlos","doi":"10.12788/fp.0373","DOIUrl":"https://doi.org/10.12788/fp.0373","url":null,"abstract":"Background: Edaravone has been shown to slow functional degeneration of amyotrophic lateral sclerosis (ALS). The primary objective of this study was to assess ALS disease progression in veterans on IV edaravone compared with veterans who received standard of care. Methods: This retrospective case-control study was conducted at a large, academic US Department of Veteran Affairs medical center. The primary endpoint was the change in baseline Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores after 6 months of IV edaravone compared with standard-of-care ALS management. The secondary outcomes included change in ALSFRS-R scores, percent forced vital capacity (%FVC) and speech intelligibility stage (SIS) 3 to 24 months after initiation of therapy, duration of edaravone completed (months), time to death (months), and safety outcomes. Results: Twenty-one edaravone and 42 standard-of-care patients were evaluated. No difference was noted in ALSFRS-R at 6 months between the edaravone and standard-of-care groups ( P = .84). Additionally, no difference was noted in change from baseline %FVC, change from baseline SIS, and time to death between the 2 groups ( P > .05). No safety events were reported in either group. Conclusions: No difference was noted in the rate of ALS disease progression between patients who received IV edaravone vs standard of care.","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83027027","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":"Discontinuing Disease-Modifying Therapies in Nonactive Secondary Progressive MS: Review of the Evidence","authors":"Natasha Antonovich","doi":"10.12788/fp.0390","DOIUrl":"https://doi.org/10.12788/fp.0390","url":null,"abstract":"Background: There are currently no disease-modifying therapies (DMTs) on the market approved for nonactive secondary progressive multiple sclerosis (SPMS), and lifelong DMTs are neither indicated nor supported by evidence. Nevertheless, the discontinuation of DMTs has been a long-debated topic with varied opinions on how and when to discontinue. Observations: This article reviews the current literature regarding the discontinuation of DMTs in nonactive SPMS. Discontinuing DMTs does not seem to have deleterious effects on the nonactive SPMS disease course and may improve quality of life. Conclusions: The growing evidence in this area may make discontinuation of DMTs in nonactive SPMS a less debatable topic, but it is still a major treatment decision that clinicians must thoroughly discuss with the patient to provide high-quality, patient-centered care.","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90351506","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":"Barriers to Implementation of Telehealth Pre-anesthesia Evaluation Visits in the Department of Veterans Affairs.","authors":"Atilio Barbeito,&nbsp;Karthik Raghunathan,&nbsp;Samantha Connolly,&nbsp;Edward R Mariano,&nbsp;Jeanna Blitz,&nbsp;Randall S Stafford,&nbsp;Sesh Mudumbai","doi":"10.12788/fp.0387","DOIUrl":"10.12788/fp.0387","url":null,"abstract":"<p><strong>Background: </strong>Evaluations are conducted days or weeks before a scheduled surgical or invasive procedure involving anesthesia to assess patients' preprocedure condition and risk, optimize status, and prepare them for their procedure. The traditional pre-anesthesia evaluation is conducted in person, although telehealth modalities have been used for several years and have accelerated since the advent of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We surveyed 109 anesthesiology services to understand the barriers and facilitators to the adoption of telephone- and video-based pre-anesthesia evaluation visits within the US Department of Veterans Affairs (VA).</p><p><strong>Results: </strong>The analysis included 55 responses from 50 facilities. Twenty-two facilities reported using both telephone and video, 11 telephone only, 5 video only, and 12 none of these modalities. For telehealth users, the ability to obtain a history of present illness, the ability to assess for comorbidities, and assess for health habits were rated highest while assessing nutritional status was lowest. Among nonusers of telehealth modalities, barriers to adoption included the inability to perform a physical examination and the inability to obtain vital signs. Respondents not using telephone cited concerns about safety, while respondents not using video also cited lack of information technology and staff support and patient-level barriers.</p><p><strong>Conclusions: </strong>We found no significant perceived advantages of video over telephone in the ability to conduct routine pre-anesthesia evaluations except for the perceived ability to assess nutritional status. Clinicians with no telehealth experience cited the inability to perform a physical examination and obtain vital signs as the most significant barriers to implementation. Future work should focus on delineating the most appropriate and valuable uses of telehealth for pre-anesthesia evaluation and/or optimization.</p>","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588996/pdf/fp-40-07-210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695353","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":"Fireworks, Veterans, and PTSD: The Ironies of the Fourth of July.","authors":"Cynthia Geppert","doi":"10.12788/fp.0394","DOIUrl":"10.12788/fp.0394","url":null,"abstract":"","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588998/pdf/fp-40-07-208.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695355","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-Led Management of HIV PrEP Within the Veterans Health Administration.","authors":"Madison A Cameron,&nbsp;Jenna Kawamoto,&nbsp;Troy A Shahoumian,&nbsp;Pamela S Belperio","doi":"10.12788/fp.0379","DOIUrl":"10.12788/fp.0379","url":null,"abstract":"<p><strong>Background: </strong>Uptake and access to HIV preexposure prophylaxis (PrEP) is key to reducing incident HIV infections. Pharmacists are one of the most accessible health care professionals in the United States and are well suited to address this need.</p><p><strong>Observations: </strong>We describe a model of care at the Veterans Affairs Greater Los Angeles Healthcare System in which clinical pharmacist practitioners developed and implemented a pharmacy-led PrEP clinic colocated within an infectious disease clinic. Veterans Health Administration clinical pharmacists provide direct patient care under a scope of practice that includes ordering and interpreting laboratory tests and providing PrEP prescriptions. To improve access and patient acceptability, we also used novel telemedicine modes of care to ensure flexible appointment scheduling.</p><p><strong>Conclusions: </strong>This model can be used by other federal and community-based health care organizations to implement interdisciplinary pharmacist-managed PrEP clinics and expand telehealth modalities to deliver outpatient services.</p>","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":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588999/pdf/fp-40-07-218.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695356","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 Critical Value of Telepathology in the COVID-19 Era.","authors":"Jeffrey M Petersen,&nbsp;Nirag Jhala,&nbsp;Darshana N Jhala","doi":"10.12788/fp.0381","DOIUrl":"10.12788/fp.0381","url":null,"abstract":"<p><strong>Background: </strong>Telepathology, which includes the use of telecommunication links, helps enable transmission of digital pathology images for primary diagnosis, quality assurance, education, research, or second opinion diagnoses.</p><p><strong>Observations: </strong>This review covers all aspects of telepathology implementation, including the selection of platforms, budgets and regulations, validation, implementation, education, quality monitoring, and the potential to improve practice. Considering the long-term trends, the lessons of the COVID-19 pandemic, and the potential for future pandemics or other disasters, the validation and implementation of telepathology remains a reasonable choice for laboratories looking to improve their practice.</p><p><strong>Conclusions: </strong>Though barriers to implementation exist, there are potential benefits, such as the wide spectrum of uses like frozen section, telecytology, primary diagnosis, and second opinions. Telepathology represents an innovation that may transform the future of pathology practice.</p>","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":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10584409/pdf/fp-40-06-186.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686597","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":"Frailty Trends in an Older Veteran Subpopulation 1 Year Prior and Into the COVID-19 Pandemic Using CAN Scores.","authors":"Nalini S Bhalla,&nbsp;Janet Fawcett","doi":"10.12788/fp.0385","DOIUrl":"10.12788/fp.0385","url":null,"abstract":"<p><strong>Background: </strong>We studied the effects of the first year of the COVID-19 pandemic on frailty trends in a subset of older veterans at the Phoenix Veterans Affairs Health Care System.</p><p><strong>Methods: </strong>We identified 3538 and 6103 veterans aged 70 to 75 years as of February 8, 2019, with a calculated Care Assessment Need (CAN) score of ≥ 75 for 1-year mortality and hospitalization, respectively. After excluding veterans with insufficient 2020 and 2021 data, we compared the difference in 1-year mortality and hospitalization CAN scores from 2019 to 2020 with 2020 to 2021 using a paired <i>t</i> test.</p><p><strong>Results: </strong>The difference in mean (SD) 1-year mortality CAN scores from 2020 to 2021 was 0.2 (13.4) when compared with the previous year's -4.9 (12.5) (<i>P</i> < .0001), indicating increased frailty. The difference in 1-year hospitalization CAN scores from 2020 to 2021 was -1.5 (12.0) when compared with the previous year's -2.8 (9.9) (<i>P</i> < .0001).</p><p><strong>Conclusions: </strong>Frailty in our veteran subpopulation as calculated by 1-year mortality CAN scores increased in the first year of the COVID-19 pandemic when compared with a recovering trend the previous year.</p>","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":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10584405/pdf/fp-40-06-194.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686593","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}