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

{"title":"Where Have All the Future Veterans Gone?","authors":"Cynthia Geppert","doi":"10.12788/fp.0436","DOIUrl":"https://doi.org/10.12788/fp.0436","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"40 11","pages":"366-367"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856359","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":"Elective Hand Surgery and Antithrombotic Use in Veterans.","authors":"Loretta Coady-Fariborzian, Peter Vonu, Christy Anstead","doi":"10.12788/fp.0430","DOIUrl":"https://doi.org/10.12788/fp.0430","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing plastic surgery have traditionally been instructed to avoid anticoagulants and antiplatelets during the perioperative period to avoid bleeding that could lead to painful hematomas, skin necrosis, unplanned procedures, and blood transfusions. Many veterans are currently prescribed anticoagulants for prevention of life- and limb-threatening embolic and thrombotic events. In early 2015, the plastic surgery service began to instruct patients undergoing elective hand surgery to stay on their prescription anticoagulant perioperatively. The objective of this study was to determine the postoperative bleeding complication rate, if any, over a 7.5-year period in patients who did not interrupt their prescription anticoagulants.</p><p><strong>Methods: </strong>Health records at the Malcom Randall Veterans Affairs Medical Center in Gainesville, Florida, were queried for all plastic surgery cases performed from January 1, 2015, through June 30, 2022. Elective hand cases were identified based on the operation description and included carpal tunnel decompression (endo and open), cubital tunnel decompression (in situ), trigger finger release, trapeziectomy, small-joint fusion, neurectomy, elective amputations, and benign neoplasm removals. Patient history and physicals notes were reviewed for mention of a prescription anticoagulant on their medication list and for instructions to not discontinue blood thinner use. The postoperative notes were reviewed for up to 30 days to look for evidence of postoperative bleeding complications.</p><p><strong>Results: </strong>One hundred seventy-eight patients were identified for maintaining prescription blood thinners during their elective hand surgery. There was 1 major complication (0.6%) when a patient had to return to surgery for emergent control of bleeding. This was an in situ cubital tunnel release on clopidogrel and aspirin. There were 4 minor bleeding complications (2.2%) that were treated in the clinic with compression, wound care, or expedited follow-up for reassurance.</p><p><strong>Conclusions: </strong>Continuing prescription anticoagulants and antiplatelets during the perioperative period for elective hand surgery is a safe practice with an acceptably low local complication rate.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"40 11","pages":"374-377"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871768","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":"Monitoring Thyrotropin in Veterans With Thyroid Nodules.","authors":"Sabrina Kaul, Ankur Gupta","doi":"10.12788/fp.0431","DOIUrl":"https://doi.org/10.12788/fp.0431","url":null,"abstract":"<p><strong>Background: </strong>After the initial thyroid nodule diagnosis, a patient's thyrotropin is often monitored. However, the American Thyroid Association guidelines do not offer recommendations for follow-up thyrotropin testing for patients with thyroid nodules who have no history of conditions or known medications that affect thyroid hormone levels.</p><p><strong>Methods: </strong>At the Veterans Affairs Dayton Healthcare System in Ohio, we conducted a retrospective chart review from January 2010 to December 2016 of 100 patients diagnosed with ≥ 1 thyroid nodule on imaging studies who had normal blood thyrotropin at the time of nodule diagnosis. The thyrotropin value was studied at and after diagnosis. A 95% CI was determined for the true population rate of patients with an abnormal thyrotropin at their most recent testing. χ² tests for categorical variables and independent sample <i>t</i> tests for continuous variables were used to compare the abnormal and normal most recent thyrotropin groups.</p><p><strong>Results: </strong>One hundred patients (male [83%], White race [82%]) with normal thyrotropin at nodule diagnosis had thyrotropin monitoring for a mean (SD) of 5.7 (2.5) years. Six of 100 patients (6%; 95% CI, 2.5%-12.7%) developed abnormal thyrotropin levels in a mean (SD) of 6.9 (3.1) years. When comparing the 6 patients with abnormal thyrotropin vs the 94 with normal thyrotropin, there were no significant differences in sex (<i>P</i> = .99), race (<i>P</i> = .55), age at diagnosis (<i>P</i> = .12), initial thyrotropin level (<i>P</i> = .24), most recent thyrotropin level (<i>P</i> = .98), or time from diagnosis to most recent thyrotropin level (<i>P</i> = .23).</p><p><strong>Conclusions: </strong>This study found no significant change in thyrotropin levels over time in patients with thyroid nodules and no history of medical conditions or medications known to affect thyrotropin levels. Monitoring thyrotropin over time may not be required in these patients. More studies are needed to provide additional data on thyrotropin monitoring for thyroid nodules so that clinicians can make evidence-based decisions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"40 11","pages":"378-382"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869730","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":"VA Big Data Science: A Model for Improved National Pandemic Response Present and Future","authors":"Yinong Young-Xu","doi":"10.12788/fp.0412","DOIUrl":"https://doi.org/10.12788/fp.0412","url":null,"abstract":"Background: The US Department of Veterans Affairs (VA) enterprise approach to research (VA Research) has built a data-sharing framework available to all research teams within VA. Combined with robust analytic systems and tools available for investigators, VA Research has produced actionable results during the COVID-19 pandemic. Big data science techniques applied to VA’s health care data demonstrate that medical research can be performed quickly and judiciously during nationwide health care emergencies. Observations: We envision a common framework of data collection, management, and surveillance implemented in partnership with other health care agencies that would capture even broader, actionable, and timely observational data on populations, while providing opportunities for enhanced collaborative research across agencies. This model should be continued and expanded through the current COVID-19 and future pandemics. Conclusions: Extending the achievements of VA Research in the COVID-19 pandemic to date, we advocate national goals of open science by working toward a synergistic national framework of anonymized, synchronized, shared health data that would provide researchers with potent tools to combat future public health crises.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"103 3-4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135271654","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":"Abdominal Pain and Fever 48 Hours After Hysterosalpingography.","authors":"Andrew Evans, Roland Kiendrebeogo, Grace Covelli, Christopher Russo, Caitlin Christoffel","doi":"10.12788/fp.0428","DOIUrl":"https://doi.org/10.12788/fp.0428","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"40 11","pages":"389-392"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861439","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":"Foreword: VA Research and COVID-19","authors":"Shereef Elnahal","doi":"10.12788/fp.0427","DOIUrl":"https://doi.org/10.12788/fp.0427","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"7 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135326012","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":"Nightmare on CIL Street: A Simulation Series to Increase Confidence and Skill in Responding to Clinical Emergencies.","authors":"Nikhil Seth, Michael T Finch","doi":"10.12788/fp.0432","DOIUrl":"https://doi.org/10.12788/fp.0432","url":null,"abstract":"<p><strong>Background: </strong>The Central Texas Veterans Health Care System (CTVHCS) in Temple, a 189-bed teaching hospital, recently opened its Center for Innovation and Learning for simulation-based learning. CTVHCS built a rapid response simulation curriculum to improve preparedness for internal medicine residents, medical students, and physician assistant students that exploits newly developed medical education technology.</p><p><strong>Observations: </strong>The Center for Innovation and Learning curriculum was created based on the most common rapid response calls received over the previous 3 years. Cardiac, respiratory, and neurological simulations were implemented. Learners approach each scenario as if they were on night service alone without specialist help. Learners must identify tachyarrhythmia, impending respiratory failure, and a patient with encephalopathy requiring transfer.</p><p><strong>Conclusions: </strong>Sixteen learners were surveyed before the simulation and after addressing each educational objective was completed and showed improvement. Educating trainees on rapid response scenarios by using a simulation curriculum provides many benefits. Trainees reported improvement in addressing cardiac, respiratory, and neurological rapid response scenarios after experiencing the simulation.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"40 11","pages":"383-387"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872844","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":"VA Lessons From Partnering in COVID-19 Clinical Trials","authors":"Krissa Caroff","doi":"10.12788/fp.0415","DOIUrl":"https://doi.org/10.12788/fp.0415","url":null,"abstract":"Background: The US Department of Veterans Affairs (VA) Office of Research and Development (ORD) supports an extensive clinical trials enterprise. Until recently, external partnerships were limited. The VA’s potential value as a partner became more apparent during the COVID-19 pandemic because of its large health care system, diverse patient population, and expertise in conducting clinical trials. Observations: By leveraging its infrastructure, the VA was able to participate in 7 large-scale COVID-19 therapeutic and vaccine trials. A key aspect of this enterprise approach is the ability to provide centralized direction and coordination. The VA’s partnerships with external groups offered insights into the challenges associated with conducting important trials, especially when rapidity and coordination were essential. The ORD also developed solutions for reducing study startup time that could be established as best practices. We offer lessons for the challenges VA faced: site infrastructure needs and capabilities; study management roles and responsibilities; educational resources; local review; study design demands; contracting and budgeting; central-level systems; and communication. Conclusions: VA participation in major COVID-19 therapeutic and vaccine trials represented a significant part of its research response to the pandemic. These contributions extended beyond the participants, scientists, and data that helped inform subsequent regulatory approvals. The VA also had an opportunity to directly develop partnerships with non-VA groups. These groups became more familiar with the VA while enabling us to gain more experience in the diverse practices used to conduct multisite clinical studies. Ultimately, these efforts empower the VA to further serve the broader scientific and clinical communities.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"10 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135326001","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":"Leveraging the Million Veteran Program Infrastructure and Data for a Rapid Research Response to COVID-19","authors":"Stacey B Whitbourne","doi":"10.12788/fp.0416","DOIUrl":"https://doi.org/10.12788/fp.0416","url":null,"abstract":"Background: The Veterans Health Administration Office of Research and Development (ORD) played a key role in the federal government’s response to the COVID-19 pandemic. The ORD effectively leveraged existing resources to answer questions related to the SARS-CoV-2 virus and COVID-19. Observations: When the COVID-19 pandemic hit in 2020, the Million Veteran Program (MVP), one of the largest genomic cohorts in the world, extended the centralized recruitment and enrollment infrastructure to develop a COVID-19 research volunteer registry to assist enrollment in the vaccine and treatment trials in which the US Department of Veterans Affairs (VA) participated. In addition, the MVP allowed for new data collection and a large genomic cohort to understand host contributions to COVID-19. This article describes ways the MVP contributed to the VA’s rapid research response to COVID-19. Several host genetic factors believed to play a role in the development and severity of COVID-19 were identified. Furthermore, existing MVP partnerships with other federal agencies, particularly with the Department of Energy, were leveraged to improve understanding and management of COVID-19. Conclusions: A previously established enterprise approach and research infrastructure were essential to the VA’s successful and timely COVID-19 research response. This infrastructure not only supported rapid recruitment in vaccine and treatment trials, but also leveraged the unique MVP and VA electronic health record data to drive rapid scientific discovery and inform clinical operations. Extending the models that VA research applied to the federal government at large and establishing centralized resources for shared or federated data analyses across federal agencies will better equip the nation to respond to future public health crises.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"5 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135326018","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":"Nephrology–Palliative Care Collaboration to Promote Outpatient Hemodialysis Goals of Care Conversations","authors":"Alexi Vahlkamp","doi":"10.12788/fp.0422","DOIUrl":"https://doi.org/10.12788/fp.0422","url":null,"abstract":"Background: Goals of care conversations and corresponding life-sustaining treatment (LST) progress notes were completed for only one-fourth of patients on outpatient dialysis despite hospital-wide training with nephrologists at the Edward Hines, Jr. Veterans Affairs Hospital. The purpose of this quality improvement project was to increase completion of LST progress notes and corresponding orders among patients on dialysis through an interdisciplinary nephrology–palliative care collaboration. Observations: The nephrology and palliative care departments began an interdisciplinary collaboration for nephrology to consult palliative care to initiate goals of care conversations and complete LST progress notes with patients on dialysis. A coordinated workflow process was created that included multidisciplinary efforts for patient selection, patient education, and introduction and completion of goals of care conversations for patients on dialysis. Completion rates for LST notes increased from 27% to 81% following the 13-month intervention, with 69 of 85 patients having a documented LST progress note. Conclusions: A collaboration between nephrology and palliative care increased high-quality LST progress note completion. The next steps include expanding these collaborations at other dialysis units and evaluating the impact on patient outcomes.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135654241","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}