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

{"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}

{"title":"Pyogenic Hepatic Abscess in an Immunocompetent Patient With Poor Oral Health and COVID-19 Infection.","authors":"Manuel Vazquez,&nbsp;Alana Vassil,&nbsp;Igor Sirotkin","doi":"10.12788/fp.0382","DOIUrl":"10.12788/fp.0382","url":null,"abstract":"<p><strong>Background: </strong>Pyogenic hepatic abscess (PHA) is a collection of pus in the liver caused by bacterial infection of the liver parenchyma. PHA is more common in immunosuppressed individuals and those with diabetes mellitus, cancer, and liver transplant.</p><p><strong>Case presentation: </strong>We present a rare case of PHA with <i>Fusobacterium nucleatum</i> in an immunocompetent patient with poor oral health, history of diverticulitis, and recent COVID-19 infection whose only symptoms were chest pain and a 4-week history of fever and malaise. The source of infection in this patient was likely dental caries and periodontal disease, with COVID-19 infection playing a role as a red herring in this patient's disease progression, delaying diagnosis.</p><p><strong>Conclusions: </strong>Diagnosis and treatment of PHA must be prompt with drainage and empiric anaerobic coverage followed by a more tailored antibiotic regimen if indicated by culture and further drainage if indicated by computed tomography.</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/PMC10584407/pdf/fp-40-06-182.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686596","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":"Impact of Pharmacist Interventions at an Outpatient US Coast Guard Clinic.","authors":"Fengyee Zhou,&nbsp;Zachary Woodward","doi":"10.12788/fp.0383","DOIUrl":"https://doi.org/10.12788/fp.0383","url":null,"abstract":"<p><strong>Background: </strong>US Coast Guard (USCG) active-duty service members (ADSMs) are required to maintain medical readiness to maximize operational success. USCG pharmacists serve the traditional pharmacist role while maintaining oversight of regional pharmaceutical services. This study aimed to quantify the number, duty status impact, and replicability of medication interventions made by one pharmacist at the USCG Base Alameda clinic in California over 6 months.</p><p><strong>Methods: </strong>Medication interventions made at the USCG Base Alameda clinic from July 1, 2021, to December 31, 2021, were categorized as a drug therapy problem (DTP) or non-DTP. Each DTP was further evaluated in a retrospective record review by a panel of USCG pharmacists to assess 2 additional factors: duty status severity (potential to affect duty status) and replicability (potential for the same intervention to be made in the absence of access to the patient health record).</p><p><strong>Results: </strong>USCG Base Alameda pharmacy dispensed 1751 prescriptions and made 116 interventions (7%), of which 111 (96%) were accepted by the prescriber. Of the interventions, 64 (55%) were DTPs, and 14 of those (22%) had potential to change duty status, and 18 DTPs (28%) were made because the pharmacist had access to the health record.</p><p><strong>Conclusions: </strong>Pharmacists' role in USCG clinics includes collaborating with the patient care team to make medication interventions that have significant impact on ADSMs' wellness and the USCG mission.</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/PMC10584406/pdf/fp-40-06-174.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686594","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 Antimicrobial Stewardship and Antibiotic Use in Hospitalized Patients With COVID-19.","authors":"Selena N Pham,&nbsp;Taylor M Hori,&nbsp;Ashfaq Shafiq","doi":"10.12788/fp.0380","DOIUrl":"10.12788/fp.0380","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, a significant increase in the use of empiric antibiotic therapy has been observed especially in patients hospitalized with COVID-19. Improving antibiotic prescribing is one of the main goals of the antimicrobial stewardship program (ASP). The ASP pharmacists have a scope of practice that authorizes changes in anti-infective therapy.</p><p><strong>Methods: </strong>We aimed to describe antibiotic prescribing in patients hospitalized with COVID-19 at Veterans Affairs Southern Nevada Healthcare System with a pharmacist-led ASP and to determine the prevalence of bacterial coinfection in this patient population. We performed a retrospective chart review of patients admitted to the facility from November 1, 2020, to January 31, 2021.</p><p><strong>Results: </strong>A total of 199 patients were admitted to the hospital for laboratory-confirmed COVID-19 infection during the study period and 61 patients (31%) received ≥ 1 antibiotic on hospital admission and 138 (69%) did not receive antibiotics. Forty-seven patients (77%) had antibiotics discontinued by the ASP team within 72 hours of admission. Of the 199 admitted, 6 (3%) had microbiologically confirmed bacterial coinfection. <i>Pseudomonas aeruginosa</i> was the most common organism (3 sputum cultures) followed by <i>Klebsiella oxytoca</i> (2 sputum cultures). Sixteen patients (8%) developed a nosocomial infection during their hospital stay.</p><p><strong>Conclusions: </strong>Up to 31% of patients hospitalized for COVID-19 infection received empiric antibiotic treatment for concern of bacterial coinfection. Pharmacist-led ASP led to early discontinuation of antibiotics in many patients. A thorough clinical workup to determine the risk of bacterial coinfection in patients with COVID-19 is important before starting empiric antibiotic therapy. It is essential to continue promoting the ASP during the COVID-19 pandemic to ensure responsible antibiotic use and prevent antimicrobial resistance.</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/PMC10584410/pdf/fp-40-06-178.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686595","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}