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

{"title":"Proactive Strategies for Mitigating Cardiopulmonary Risk in COPD.","authors":"Barbara Yawn, Robert Chilton","doi":"10.12788/fp.0639","DOIUrl":"10.12788/fp.0639","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 Suppl5","pages":"S31-S36"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842699","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":"Beyond PPIs: New Options for Treating GERD.","authors":"Colin W Howden, Carol M Antequera","doi":"10.12788/fp.0635","DOIUrl":"10.12788/fp.0635","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 Suppl5","pages":"S7-S12"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842704","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":"Empowering Culture Change and Safety on the Journey to Zero Harm With Huddle Cards.","authors":"Michael T Finch, Brandon Mason, Nicole Volek, Brittany Phillips, Jennifer Shoaf, Debbie Brown, Ashley R McCormack, Jessica J Estell","doi":"10.12788/fp.0597","DOIUrl":"10.12788/fp.0597","url":null,"abstract":"<p><strong>Background: </strong>Safety event reporting plays an important role in improving patient safety. The US Department of Veterans Affairs has focused on minimizing or eliminating harm to patients.</p><p><strong>Observations: </strong>The patient safety (PS) and high reliability organization (HRO) teams at the Central Texas Veterans Health Care System (CTVHCS) developed an education model that integrates the Joint Patient Safety Reporting System (JPSR) into huddles. JPSR Huddle Cards provide frontline staff and management with guidance on the purpose of the JPSR, the difference between an adverse event and a near miss, what root causes are, the lifespan of a JPSR, how to celebrate reporting, and key fact checks. Six cards were presented to staff (1 per week) during morning safety huddles to support the CTVHCS journey to high reliability. Participants completed a survey on safety before and after receiving the cards.</p><p><strong>Conclusions: </strong>Posttest scores were consistently higher than pretest scores, with an average increase of around 2 standard deviations across all questions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"336-340"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517833","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":"VIP Boot Camp: Expanding the Impact of VA Primary Care Mental Health With a Transdiagnostic Modular Group Program.","authors":"Meghan Rooney, Carolyn E Davidson","doi":"10.12788/fp.0622","DOIUrl":"10.12788/fp.0622","url":null,"abstract":"<p><strong>Background: </strong>Veterans' Intensive Primary Care Mental Health Integration (PCMHI) (VIP) Boot Camp is an evidence-informed group psychotherapy program that provides comprehensive mental health treatment to veterans. Launched in 2022, VIP Boot Camp uses a rolling, modular stepped-care model to address common challenges faced by veterans: sleep difficulties, chronic pain, and emotion regulation.</p><p><strong>Observations: </strong>The program aims to improve access to mental health treatment and reduce wait times by increasing the number of veterans treated within the PCMHI program and reducing reliance on specialty and higher-level mental health services. Beginning within the Veterans Integrated Service Networks (VISN) 9 Clinical Resource Hub, VIP Boot Camp has expanded to 8 virtual VISN 9 Boot Camps, with plans for continued growth. A 3-day intensive education program trains clinicians to launch a VIP Boot Camp. To date, PCMHI clinicians have been trained in 3 additional VISNs.</p><p><strong>Conclusions: </strong>VIP Boot Camp addresses interconnections among multiple presenting issues, veteran empowerment, social group engagement, and a holistic transdiagnostic approach. A training program helps health care professionals establish a VIP Boot Camp. This model of integrative mental health treatment in PCMHI offers benefits to veterans, clinicians, and the Veterans Health Administration system.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517801","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":"E-Consults Bridge to Interdisciplinary Team Care for Rural Appalachian Veterans With Chronic Pain and Opioid Use Disorder.","authors":"Rena E Courtney, Corinne N Kacmarek, Monica St Jacques, Melissa Truitt, Katerina Mastronardi, Tanvi Patil, William C Becker, Anne Black","doi":"10.12788/fp.0618","DOIUrl":"10.12788/fp.0618","url":null,"abstract":"<p><strong>Background: </strong>Co-occurring chronic pain and opioid use disorder (OUD) is often managed by primary care practitioners (PCPs) for rural veterans. Interdisciplinary teams (IDTs) and e-consults have shown promise at the US Department of Veterans Affairs for supporting PCPs. This quality improvement study sought to examine the impact of an e-consult service on pain care trajectories, determine the feasibility and reach of the RESTORE IDT appointment program, and determine the impact of RESTORE on engagement in evidence-based care.</p><p><strong>Observations: </strong>A retrospective chart review was conducted at the Salem Veterans Affairs Healthcare System that primarily serves rural veterans in Central Appalachia. Veterans at risk for OUD with co-occurring chronic pain whose PCP placed an e-consult during a 1-year period were included. The following data were extracted from the electronic health record: demographics, referrals, treatment plans, and treatment engagement. Results were summarized using descriptive statistics. Of the 77 e-consults placed in 1 year, 75% were placed by PCPs, and 83% were requests for recommendations on medication adjustments. The reviewing pharmacist referred 19 veterans to RESTORE; of those, 17 (89%) agreed to be referred to a pain IDT specializing in nonpharmacologic pain management and 13 (68%) agreed to initiate buprenorphine.</p><p><strong>Conclusions: </strong>This study demonstrated preliminary support for the feasibility of e-consults to increase engagement in evidence-based treatments. Additional research is needed.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"348-351"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517780","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":"When The Giants and Those Who Stand on Their Shoulders Are Gone: The Loss of VA Institutional Memory.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0625","DOIUrl":"10.12788/fp.0625","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"328-329"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517550","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":"Quality of Life for Males With Abdominal Aortic Aneurysm.","authors":"Désiré M Kindarara, Kevin C Chun, Sandipan Datta, Richard C Anderson, Zachary T Irwin, Elise A Newton, Jorge DelPozo, Behnaz Hekmat-Datta, Eugene S Lee","doi":"10.12788/fp.0626","DOIUrl":"10.12788/fp.0626","url":null,"abstract":"<p><strong>Background: </strong>Abdominal aortic aneurysm (AAA), with rupture as the major consequence, is a life-threatening disease. Although screening programs for AAA reduce mortality, it is unclear how a diagnosis impacts quality of life (QoL) in males. This study sought to measure the change in QoL for males with AAA at baseline and after 12 months.</p><p><strong>Methods: </strong>Between January 1, 2019, and February 28, 2022, males with AAA completed the 12-item short form health survey version 2 (SF-12v2) at baseline and after 12 months. SF-12v2 measures general health, physical functioning, role limitations, bodily pain, vitality, social functioning, role-emotional, and mental health. Clinical risk factors including age, race, body mass index, diabetes, hypertension, hyperlipidemia, coronary artery disease, cerebrovascular accident, myocardial infarction, and smoking status were also collected.</p><p><strong>Results: </strong>Ninety-one patients with an AAA were followed in a vascular clinic and completed the SF-12v2. The mean (SD) age was 76.0 (5.6) years and body mass index was 29.7 (6.4). The change in SF-12v2 scores from baseline to 12 months showed statistically significant improvement in QoL for general health (<i>P</i> < .05) and bodily pain (<i>P</i> < .05) domains. No significant differences were observed in other domains.</p><p><strong>Conclusions: </strong>After 12 months, males with AAA reported statistically significant higher QoL scores in general health and bodily pain. These results suggest the need for periodic QoL assessments to track changes over time for males with AAA.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517778","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":"Advanced Imaging Techniques Use in Giant Cell Arteritis Diagnosis: The Experience at Walter Reed National Military Medical Center.","authors":"Nicholas Lehman, Alexander Choi, Kenneth Dalton, John Choi","doi":"10.12788/fp.0623","DOIUrl":"10.12788/fp.0623","url":null,"abstract":"<p><strong>Background: </strong>If not diagnosed in a timely manner, giant cell arteritis (GCA) can lead to significant morbidity. The 1990 American College of Rheumatology criteria for GCA do not include screening technologies, though proposed criteria do.</p><p><strong>Methods: </strong>This study evaluated current clinical practices in diagnosing GCA and the use of screening technologies such as ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). A retrospective chart review was conducted of patients who underwent diagnostic testing for GCA from 2016 through 2022 at Walter Reed National Military Medical Center.</p><p><strong>Results: </strong>Seventy-eight charts were reviewed; 42 patients (54%) had a GCA diagnosis and 36 patients (46%) were GCA negative. Temporal artery biopsy was positive for 19 (45%) patients. Most patients did not undergo bilateral temporal artery biopsies despite recommendations. Among those diagnosed with GCA, 29 (69%) underwent biopsy, and 25 (60%) received diagnostic imaging.</p><p><strong>Conclusions: </strong>Evidence supports the use of additional screening tools beyond clinical and laboratory data to improve the diagnostic yield of temporal artery biopsy. Initial screening with ultrasound is a cost-effective and widely available modality that may reduce the risk of false-negative biopsy results. Other tests include vascular MRI/CT and PET. The target goal is to increase the diagnostic yield of temporal artery biopsies to ≥ 70%.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"330-335"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517828","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":"Streamlined Testosterone Order Template to Improve the Diagnosis and Evaluation of Hypogonadism in Veterans.","authors":"Radhika Narla, Daniel Mobley, Ethan Nguyen, Cassandra Song, Alvin M Matsumoto","doi":"10.12788/fp.0612","DOIUrl":"10.12788/fp.0612","url":null,"abstract":"<p><strong>Background: </strong>Poor adherence to evidence-based guidelines for diagnosing hypogonadism prior to initiating testosterone replacement therapy (TRT), has prompted recommendations for clinical practice improvement. This quality improvement study examined whether a testosterone order template (TOT) could improve adherence to evidence-based guidelines.</p><p><strong>Methods: </strong>A retrospective review examined male patients aged > 18 years with no prior VA testosterone prescription and ≥ 2 clinic visits who received a new testosterone prescription before TOT implementation vs postimplementation. Signs and symptoms of hypogonadism, ≥ 2 serum testosterone and gonadotropin measurements, TRT risks and benefits, and an updated hematocrit test within 6 months prior to TRT were documented.</p><p><strong>Results: </strong>Fifty-six patients in the pretemplate period and 40 patients in the posttemplate period were included. In the posttemplate period, 37 patients (93%) had documented signs and symptoms of hypogonadism compared with 40 patients (71%) in the pretemplate period (<i>P</i> = .002). Measurements of testosterone, gonadotropins, and hematocrit were higher in the posttemplate period (78%) vs pretemplate period (55%) (<i>P</i> = .03). Education regarding the risks and benefits of TRT was provided to 58% of patients posttemplate vs 34% of patients pretemplate (<i>P</i> = .02). Documentation of guideline recommendations was higher in the posttemplate period (45%) vs the pretemplate period (18%) (<i>P</i> = .004).</p><p><strong>Conclusions: </strong>TOT implementation is a feasible approach to improve clinical diagnosis and hypogonadism evaluation before TRT. The low proportion of men who received education regarding the risks and benefits of TRT and adherence to guideline recommendations after implementation underscores the need for additional efforts to improve guideline adherence and clinical practice.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517792","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":"Unique Presentation of Postpartum Hypereosinophilic Syndrome With Atypical Features and Therapeutic Challenges.","authors":"Vishaka R Hatcher, Rani R Patel, Meredith M Schuldt","doi":"10.12788/fp.0621","DOIUrl":"10.12788/fp.0621","url":null,"abstract":"<p><strong>Background: </strong>Hypereosinophilic syndrome (HES) is an assemblage of disorders leading to marked eosinophilic tissue infiltration resulting in organ dysfunction. This case report describes a challenging diagnosis of HES identified in the postpartum period, a rare presentation of this disease process.</p><p><strong>Case presentation: </strong>A 32-year-old active-duty service member with allergic rhinitis and childhood eczema developed a progressive pruritic rash and severe, recurrent epigastric pain with vomiting and weight loss 3 months following the birth of her first child. The patient gradually developed intermittent facial swelling, night sweats, and dyspnea, resulting in hospitalization. Two absolute eosinophil counts (AECs) taken more than a month apart ranged from 1600 to 4787 cells/μL. Mature eosinophils were found on skin, bone marrow, and duodenal biopsies. Radiography revealed no detectable neoplasm, and there was no clinical evidence of cardiac involvement. Testing revealed no mutations indicative of familial, myeloproliferative, or lymphocytic variants. The patient was started on empiric treatment with symptom improvement, which was gradually discontinued due to a second pregnancy.</p><p><strong>Conclusions: </strong>The patient described in this case met diagnostic criteria for HES; however, the complicated clinical and laboratory features made it challenging to characterize her disease as a specific HES variant, rendering it difficult to determine the optimal treatment regimen. Further therapy was complicated by a new pregnancy. It is important for clinicians to recognize an abnormally elevated AEC, promptly initiate systematic evaluation, and minimize delays in diagnosis and treatment of potential HES in order to avoid the extensive morbidity and mortality that can be associated with HES.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"344-347"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517840","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}