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Vassy JL, Brunette CA, Yi T, Harrison A, Cardellino MP, Assimes TL, Christensen KD, Devineni P, Gaziano JM, Gong X, Hui Q, Knowles JW, Muralidhar S, Natarajan P, Pyarajan S, Sears MG, Shi Y, Sturm AC, Whitbourne SB, Sun YV, Danowski ME. Design and Pilot Results from Million Veteran Program Return Of Actionable Genetic Results (MVP-ROAR) Study. Am Heart J 2024:S0002-8703(24)00115-7. [PMID: 38762090 DOI: 10.1016/j.ahj.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND As a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care of participants. To determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return Of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as an exemplar actionable condition. METHODS The MVP-ROAR Study consists of a completed single-arm pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention. The primary outcome of the RCT is 6-month change in low-density lipoprotein cholesterol (LDL-C) between participants receiving results at baseline and those receiving results after 6 months. RESULTS The pilot developed processes to identify and recontact participants nationally with probable pathogenic variants in low-density lipoprotein receptor (LDLR) on the MVP genotype array, invite them to clinical confirmatory gene sequencing, and deliver a telegenetic counseling intervention. Among participants in the pilot phase, 8 (100%) had active statin prescriptions after 6 months. Results were shared with 16 first-degree family members. Six-month ΔLDL-C (low-density lipoprotein cholesterol) after the genetic counseling intervention was -37 mg/dL (95% CI: -12 to -61; p=0.03). The ongoing RCT will determine between-arm differences in this primary outcome. CONCLUSION While underscoring the importance of clinical confirmation of research results, the pilot phase of the MVP-ROAR Study marks a turning point in MVP and demonstrates the feasibility of returning genetic results to participants and their providers. The ongoing RCT will contribute to understanding how such a program might improve patient health care and outcomes.
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Affiliation(s)
- Jason L Vassy
- VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | | | - Thomas Yi
- VA Boston Healthcare System, Boston, MA, USA
| | | | | | | | - Kurt D Christensen
- Harvard Medical School, Boston, MA, USA; PRecisiOn Medicine Translational Research Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute
| | | | - J Michael Gaziano
- VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Xin Gong
- VA Boston Healthcare System, Boston, MA, USA
| | - Qin Hui
- Emory University Rollins School of Public Health, Atlanta, GA; VA Atlanta Healthcare System, Decatur, GA
| | | | - Sumitra Muralidhar
- Veterans Health Administration, Office of Research and Development, Washington, DC
| | - Pradeep Natarajan
- Harvard Medical School, Boston, MA, USA; Broad Institute of Harvard and MIT, Cambridge, MA
| | | | | | - Yunling Shi
- VA Boston Healthcare System, Boston, MA, USA
| | | | | | - Yan V Sun
- Emory University Rollins School of Public Health, Atlanta, GA; VA Atlanta Healthcare System, Decatur, GA
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George EL, Jacobs MA, Reitz KM, Massarweh NN, Youk AO, Arya S, Hall DE. Outcomes of Women Undergoing Noncardiac Surgery in Veterans Affairs Compared With Non-Veterans Affairs Care Settings. JAMA Surg 2024; 159:501-509. [PMID: 38416481 PMCID: PMC10902781 DOI: 10.1001/jamasurg.2023.8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/25/2023] [Indexed: 02/29/2024]
Abstract
Importance Recent legislation facilitates veterans' ability to receive non-Veterans Affairs (VA) surgical care. Although veterans are predominantly male, the number of women receiving care within the VA has nearly doubled to 10% over the past decade and recent data comparing the surgical care of women in VA and non-VA care settings are lacking. Objective To compare postoperative outcomes among women treated in VA hospitals vs private-sector hospitals. Design, Setting, and Participants This coarsened exact-matched cohort study across 9 noncardiac specialties in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) and American College of Surgeons National Surgical Quality Improvement Program (NSQIP) took place from January 1, 2016, to December 31, 2019. Multivariable Poisson models with robust standard errors were used to evaluate the association between VA vs private-sector care settings and 30-day mortality. Hospitals participating in American College of Surgeons NSQIP and VASQIP were included. Data analysis was performed in January 2023. Participants included female patients 18 years old or older. Exposures Surgical care in VA or private-sector hospitals. Main Outcomes and Measures Postoperative 30-day mortality and failure to rescue (FTR). Results Among 1 913 033 procedures analyzed, patients in VASQIP were younger (VASQIP: mean age, 49.8 [SD, 13.0] years; NSQIP: mean age, 55.9 [SD, 16.9] years; P < .001) and although most patients in both groups identified as White, there were significantly more Black women in VASQIP compared with NSQIP (29.6% vs 12.7%; P < .001). The mean risk analysis index score was lower in VASQIP (13.9 [SD, 6.4]) compared with NSQIP (16.3 [SD, 7.8]) (P < .001 for both). Patients in the VA were more likely to have a preoperative acute serious condition (2.4% vs 1.8%: P < .001), but cases in NSQIP were more frequently emergent (6.9% vs 2.6%; P < .001). The 30-day mortality, complications, and FTR were 0.2%, 3.2%, and 0.1% in VASQIP (n = 36 762 procedures) as compared with 0.8%, 5.0%, and 0.5% in NSQIP (n = 1 876 271 procedures), respectively (all P < .001). Among 1 763 540 matched women (n = 36 478 procedures in VASQIP; n = 1 727 062 procedures in NSQIP), these rates were 0.3%, 3.7%, and 0.2% in NSQIP and 0.1%, 3.4%, and 0.1% in VASQIP (all P < .01). Relative to private-sector care, VA surgical care was associated with a lower risk of death (adjusted risk ratio [aRR], 0.41; 95% CI, 0.23-0.76). This finding was robust among women undergoing gynecologic surgery, inpatient surgery, and low-physiologic stress procedures. VA surgical care was also associated with lower risk of FTR (aRR, 0.41; 95% CI, 0.18-0.92) for frail or Black women and inpatient and low-physiologic stress procedures. Conclusions and Relevance Although women comprise the minority of veterans receiving care within the VA, in this study, VA surgical care for women was associated with half the risk of postoperative death and FTR. The VA appears better equipped to meet the unique surgical needs and risk profiles of veterans, regardless of sex and health policy decisions, including funding, should reflect these important outcome differences.
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Affiliation(s)
- Elizabeth L George
- Division of Vascular Surgery, Stanford University School of Medicine, California
- Surgical Service Line, Veterans Affairs Palo Alto Healthcare System, California
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, California
| | - Michael A Jacobs
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | | | - Nader N Massarweh
- Perioperative and Surgical Care Service, Atlanta Veterans Affairs Healthcare System, Decatur, Georgia
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Ada O Youk
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, California
- Surgical Service Line, Veterans Affairs Palo Alto Healthcare System, California
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, California
| | - Daniel E Hall
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
- Department of Surgery, University of Pittsburgh, Pennsylvania
- Wolff Center, University of Pittsburgh Medical Center, Pennsylvania
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Hanson J, Hui M, Strawbridge JC, Chatterjee S, Goodyear K, Giaconi JA, Tsui I. High Rates of Eye Surgery Cancellation in Veterans Related to Mental Health. Mil Med 2024:usae230. [PMID: 38687601 DOI: 10.1093/milmed/usae230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Approximately 9 million veterans receive health care at the Veterans Health Administration, many of whom have psychiatric illnesses. The military continues to have higher rates of psychiatric illness compared to the civilian population. Having a diagnosis such as posttraumatic stress disorder or depression may create challenges in using health care services, such as surgery. The aim of this study was to evaluate eye surgery cancellation, risk factors for cancellation, and areas for intervention within the VA. MATERIALS AND METHODS This was a single-center retrospective cohort study. The Veteran Health Information Systems and Technology Architecture were queried to identify all surgical requests at the West Los Angeles VA in 2019. Data collection included sociodemographic information and comorbid medical conditions, including psychiatric illness. Exploratory analyses using univariate logistic regression were used to evaluate factors associated with surgery cancellation. RESULTS A total of 1,115 surgical requests were identified with a cancellation rate of 23.7% (n = 270). Sociodemographic factors were similar between those with completed and cancelled surgery. However, having a psychiatric diagnosis correlated with surgery cancellation. For all subspecialties, patients with schizophrenia were more likely to have cancellation (odds ratio [OR], 2.53, P = .04). For retina surgery, patients with posttraumatic stress disorder were more likely to have cancellation (OR, 4.23, P = .01). Glaucoma patients with anxiety (OR, 5.78, P = .05) and depression (OR, 4.05, P = .04) were more likely to have cancellation. CONCLUSIONS There was a significant amount of eye surgery cancellations in veterans with variation by subspecialty and comorbid conditions. Having a psychiatric illness was correlated with increased rates of surgery cancellation amongst veterans. Areas to improve surgical utilization include risk stratification and increased support of vulnerable patients before surgery.
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Affiliation(s)
- Justin Hanson
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Maggie Hui
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Jason C Strawbridge
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Sayan Chatterjee
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Kendall Goodyear
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - JoAnn A Giaconi
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
- Division of Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 , USA
| | - Irena Tsui
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
- Division of Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 , USA
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Hoang L, Mani B, Wilson G, Ogu JC, Banerjee S, Ramanan B, Modrall JG, Timaran CH, Tsai S. Impact of a Quality Improvement Initiative on Medical Management of Veterans With Peripheral Artery Disease. Am J Cardiol 2024; 221:44-49. [PMID: 38636628 DOI: 10.1016/j.amjcard.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
Guideline-directed medical therapy (GDMT) for peripheral artery disease (PAD) remains severely underused. Prevention of Amputation in Veterans Everywhere (PAVE) is a screening program designed to prevent or delay major lower extremity amputation. This study aimed to determine whether diagnosis of PAD through the PAVE program improves the prescription of GDMT in veterans with asymptomatic PAD. Patients enrolled into the PAVE program from our institution from 2020 to 2021 were included. Patients with an abnormal ankle-brachial index (ABI), defined as ABI <0.9 or >1.2, were selected for further analysis. Primary outcome was adherence to GDMT, following class I and class IIa recommendations. Secondary outcomes included changes in low-density lipoprotein (LDL), blood pressure, and hemoglobin A1c (HbA1c). A total of 6,313 patients were enrolled into the PAVE program between 2020 and 2021. Of these, 211 had abnormal ABI and were included in our analysis. With enrollment into PAVE, there was significant increase in the prescription of aspirin (74.4% vs 64.9%, p = 0.044) and statins (91.5% vs 82%, p = 0.006). The overall adherence to GDMT significantly increased (56.9% vs 38.9%, p <0.001). The number of patients needed to enroll in PAVE to improve GDMT adherence is 5.6 (95% confidence interval 3.6 to 12.3). Patients enrolled into PAVE program saw significant decreases in HbA1c, with mean decrease of 0.3 (p = 0.012) and a decrease in LDL, with a mean decrease of 6.2 (p = 0.01). In conclusion, enrollment into an amputation prevention program secondarily increased adherence to GDMT, driven by increases in the prescription of statins and aspirin, with resulting decreases in HbA1c and LDL.
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Affiliation(s)
- Lawrence Hoang
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Medicine, Methodist Health System Dallas, Dallas, Texas
| | - Bidyut Mani
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gina Wilson
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Jenifer Chisom Ogu
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Subhash Banerjee
- Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
| | - Bala Ramanan
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - J Gregory Modrall
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carlos H Timaran
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shirling Tsai
- Surgical Services, Section of Vascular Surgery, Veterans Affairs North Texas Health Care System, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Gitajn IL, Werth PM, Carlini AR, Bosse MJ, Gary JL, Firoozabadi R, Obremskey W, McKinley TO, Castillo RC, O’Toole RV. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes. JB JS Open Access 2024; 9:e23.00042. [PMID: 38196850 PMCID: PMC10773708 DOI: 10.2106/jbjs.oa.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery. Methods This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12). Results After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline. Conclusions This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Paul M. Werth
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Michael J. Bosse
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Joshua L. Gary
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Reza Firoozabadi
- University of Washington Harborview Medical Center, Seattle, Washington
| | | | - Todd O. McKinley
- Indiana University School of Medicine, Indianapolis, Indiana and
| | - Renan C. Castillo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Nazem S, Barnes SM, Forster JE, Hostetter TA, Monteith LL, Kramer EB, Gaeddert LA, Brenner LA. Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e50516. [PMID: 37999953 DOI: 10.2196/50516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. OBJECTIVE The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. METHODS We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. RESULTS Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of -3.47 (95% CI -4.78 to -2.16), -3.80 (95% CI -5.34 to -2.27), and -3.42 (95% CI -4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. CONCLUSIONS Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. TRIAL REGISTRATION ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870.
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Affiliation(s)
- Sarra Nazem
- Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, Menlo Park, CA, United States
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Sean M Barnes
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lindsey L Monteith
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily B Kramer
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Laurel A Gaeddert
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Wilson R, Cuthbertson L, Sasaki A, Russell L, Kazis LE, Sawatzky R. Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes. THE GERONTOLOGIST 2023; 63:1467-1477. [PMID: 36866495 PMCID: PMC10581377 DOI: 10.1093/geront/gnad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C). RESEARCH DESIGN AND METHODS Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability. RESULTS A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70). DISCUSSION AND IMPLICATIONS This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.
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Affiliation(s)
- Rozanne Wilson
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver, British Columbia, Canada
| | - Ayumi Sasaki
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lara Russell
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lewis E Kazis
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, Massachusetts, USA
- Department of Pulmonary Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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Bach RR, Rudquist RR. Gulf war illness inflammation reduction trial: A phase 2 randomized controlled trial of low-dose prednisone chronotherapy, effects on health-related quality of life. PLoS One 2023; 18:e0286817. [PMID: 37319244 PMCID: PMC10270619 DOI: 10.1371/journal.pone.0286817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/28/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Gulf War illness (GWI) is a deployment-related chronic multisymptom illness impacting the health-related quality of life (HRQOL) of many U.S. Military Veterans of the 1990-91 Gulf War. A proinflammatory blood biomarker fingerprint was discovered in our initial study of GWI. This led to the hypothesis that chronic inflammation is a component of GWI pathophysiology. OBJECTIVES The GWI inflammation hypothesis was tested in this Phase 2 randomized controlled trial (RCT) by measuring the effects of an anti-inflammatory drug and placebo on the HRQOL of Veterans with GWI. The trial is registered at ClinicalTrials.gov, Identifier: NCT02506192. RCT DESIGN AND METHODS Gulf War Veterans meeting the Kansas case definition for GWI were randomized to receive either 10 mg modified-release prednisone or matching placebo. The Veterans RAND 36-Item Health Survey was used to assess HRQOL. The primary outcome was a change from baseline in the physical component summary (PCS) score, a measure of physical functioning and symptoms. A PCS increase indicates improved physical HRQOL. RESULTS For subjects with a baseline PCS <40, there was a 15.2% increase in the mean PCS score from 32.9±6.0 at baseline to 37.9±9.0 after 8 weeks on modified-release prednisone. Paired t-test analysis determined the change was statistically significant (p = 0.004). Eight weeks after cessation of the treatment, the mean PCS score declined to 32.7±5.8. CONCLUSIONS The prednisone-associated improvement in physical HRQOL supports the GWI inflammation hypothesis. Determining the efficacy of prednisone as a treatment for GWI will require a Phase 3 RCT.
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Affiliation(s)
- Ronald R. Bach
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Rebecca R. Rudquist
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
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9
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Seib CD, Ganesan C, Furst A, Pao AC, Chertow GM, Leppert JT, Suh I, Montez-Rath ME, Harris AHS, Trickey AW, Kebebew E, Kurella Tamura M. Estimated Effect of Parathyroidectomy on Long-Term Kidney Function in Adults With Primary Hyperparathyroidism. Ann Intern Med 2023; 176:624-631. [PMID: 37037034 PMCID: PMC10866201 DOI: 10.7326/m22-2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Multidisciplinary guidelines recommend parathyroidectomy to slow the progression of chronic kidney disease in patients with primary hyperparathyroidism (PHPT) and an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Limited data address the effect of parathyroidectomy on long-term kidney function. OBJECTIVE To compare the incidence of a sustained decline in eGFR of at least 50% among patients with PHPT treated with parathyroidectomy versus nonoperative management. DESIGN Target trial emulation was done using observational data from adults with PHPT, using an extended Cox model with time-varying inverse probability weighting. SETTING Veterans Health Administration. PATIENTS Patients with a new biochemical diagnosis of PHPT in 2000 to 2019. MEASUREMENTS Sustained decline of at least 50% from pretreatment eGFR. RESULTS Among 43 697 patients with PHPT (mean age, 66.8 years), 2928 (6.7%) had a decline of at least 50% in eGFR over a median follow-up of 4.9 years. The weighted cumulative incidence of eGFR decline was 5.1% at 5 years and 10.8% at 10 years in patients managed with parathyroidectomy, compared with 5.1% and 12.0%, respectively, in those managed nonoperatively. The adjusted hazard of eGFR decline did not differ between parathyroidectomy and nonoperative management (hazard ratio [HR], 0.98 [95% CI, 0.82 to 1.16]). Subgroup analyses found no heterogeneity of treatment effect based on pretreatment kidney function. Parathyroidectomy was associated with a reduced hazard of the primary outcome among patients younger than 60 years (HR, 0.75 [CI, 0.59 to 0.93]) that was not evident among those aged 60 years or older (HR, 1.08 [CI, 0.87 to 1.34]). LIMITATION Analyses were done in a predominantly male cohort using observational data. CONCLUSION Parathyroidectomy had no effect on long-term kidney function in older adults with PHPT. Potential benefits related to kidney function should not be the primary consideration for PHPT treatment decisions. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Carolyn D Seib
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine; Division of General Surgery, Palo Alto Veterans Affairs Health Care System; and Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California (C.D.S.)
| | - Calyani Ganesan
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California (C.G., M.E.M.)
| | - Adam Furst
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California (A.F., A.W.T.)
| | - Alan C Pao
- Division of Nephrology, Department of Medicine, and Department of Urology, Stanford University School of Medicine, Palo Alto, California (A.C.P., J.T.L.)
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, and Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California (G.M.C.)
| | - John T Leppert
- Division of Nephrology, Department of Medicine, and Department of Urology, Stanford University School of Medicine, Palo Alto, California (A.C.P., J.T.L.)
| | - Insoo Suh
- Department of Surgery, New York University Grossman School of Medicine, New York, New York (I.S.)
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California (C.G., M.E.M.)
| | - Alex H S Harris
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, and Center for Innovation to Implementation, Veterans Affairs Palo Alto, Palo Alto, California (A.H.S.H.)
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California (A.F., A.W.T.)
| | - Electron Kebebew
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California (E.K.)
| | - Manjula Kurella Tamura
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California (M.K.T.)
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10
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Reed-Fitzke K, LeardMann CA, Wojciak AS, Ferraro AJ, Hamilton A, Duncan JM, Rull RP. Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support. J Affect Disord 2023; 325:721-731. [PMID: 36627058 DOI: 10.1016/j.jad.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous research indicates an association between adverse childhood experiences (ACES) and health outcomes; however, most of these studies rely on variable-centered techniques. This study implemented a person-centered approach to provide a more nuanced understanding of these relations. METHODS The sample consisted of 3611 male Marines who completed two surveys, one prior to service and another during or after service. A series of latent class analyses were conducted to identify homogenous subgroups, using ACE categories as indicators. Hierarchical regressions were conducted to examine the relationships between classes, deployment experiences, depression and PTSD, and social support problems. RESULTS Five classes were identified: Low Adversity (48.8 %), Low Adversity - Parental Separation (PS; 33.1 %), Elevated Adversity (7.0 %), Moderate Adversity - Violence/Safety (5.7 %), and Moderate Adversity - Parental Loss (PL; 5.4 %). Several classes were associated with outcomes; in reference to Low Adversity, Moderate Adversity - PL was associated with depression and PTSD, Elevated Adversity was associated with PTSD and social support problems, and Low Adversity - PS was associated with social support problems. Experiencing moderate to high combat appeared to modify the associations between Moderate Adversity - PL and depression and PTSD. LIMITATIONS Study sample was limited to U.S. Marines; ACEs indicators were limited to specific categories, not allowing for a full range of potential childhood traumatic experiences. CONCLUSIONS Findings suggest a nuanced connection between ACEs and mental health; using specific patterns of ACEs, particularly multifaceted indicators of adversity that are inclusive of parental absence may have more utility than the sheer number of ACEs as an indicator for those who may at a heightened risk for mental health concerns.
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Affiliation(s)
| | - Cynthia A LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA; Leidos, San Diego, CA, USA
| | | | | | | | | | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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11
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Mares JG, Lund BC, Adamowicz JL, Burgess DJ, Rothmiller SJ, Hadlandsmyth K. Differences in chronic pain care receipt among veterans from differing racialized groups and the impact of rural versus urban residence. J Rural Health 2023. [PMID: 36695646 DOI: 10.1111/jrh.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The current study aimed to identify differences in Veterans Affairs (VA) chronic pain care for Black, Asian, and Hispanic Americans, compared to non-Hispanic White Americans, and examine the intersection of race and rurality. METHODS Using national administrative data, all veterans who presented to the VA for chronic pain in 2018 were included. Demographic and comorbidity variables were built from 2018 data and health care utilization variables from 2019 data. Multivariate log-binomial regression models examined differences between racialized groups, and interactions with rural/urban residence, for each health care utilization variable. FINDINGS The full cohort included 2,135,216 veterans with chronic pain. There were no differences between racialized groups in pain-related primary care visits. Black Americans were less likely to receive pain clinic visits (aRR = 0.87, CI: 0.86-0.88). Rurality further decreased the likelihood of Black Americans visiting a pain clinic. Black, Hispanic, and Asian Americans were more likely to receive pain-related physical therapy visits relative to White Americans. Black and Hispanic Americans were more likely to present to emergency/urgent care for chronic pain. While there were no differences in pain-related primary care visits, the decreased likelihood of pain clinic visits and increased use of emergency department/urgent care among Black Americans could indicate inadequate management of chronic pain. CONCLUSIONS Tailored strategies are needed to provide equitable care that meets the needs of patients from racialized groups while accounting for systemic and cultural factors.
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Affiliation(s)
- Jasmine G Mares
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Brian C Lund
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Jenna L Adamowicz
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Psychological & Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Diana J Burgess
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Shamira J Rothmiller
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Counselor Education, University of Iowa, Iowa City, Iowa, USA
| | - Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
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12
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Bishawi M, Hattler B, Almassi GH, Quin JA, Grover FL, Collins JF, Ebrahimi R, Wolbrom DH, Shroyer AL. Health-related quality of life impacts upon 5-year survival after coronary artery bypass surgery. J Card Surg 2022; 37:4899-4905. [PMID: 36423254 DOI: 10.1111/jocs.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality. METHODS This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05). RESULTS Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p < .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality. CONCLUSIONS Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.
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Affiliation(s)
- Muath Bishawi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacquelyn A Quin
- Department of Surgery, Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Frederick L Grover
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, USA
| | - Ramin Ebrahimi
- Department of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Wolbrom
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
| | - A Laurie Shroyer
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
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13
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Seib CD, Ganesan C, Arnow KD, Pao AC, Leppert JT, Barreto NB, Kebebew E, Kurella Tamura M. Kidney Stone Events Following Parathyroidectomy vs Nonoperative Management for Primary Hyperparathyroidism. J Clin Endocrinol Metab 2022; 107:e2801-e2811. [PMID: 35363858 PMCID: PMC9202696 DOI: 10.1210/clinem/dgac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is associated with an increased risk of kidney stones. Few studies account for PHPT severity or stone risk when comparing stone events after parathyroidectomy vs nonoperative management. OBJECTIVE Compare the incidence of kidney stone events in PHPT patients treated with parathyroidectomy vs nonoperative management. DESIGN Longitudinal cohort study with propensity score inverse probability weighting and multivariable Cox proportional hazards regression. SETTING Veterans Health Administration integrated health care system. PATIENTS A total of 44 978 patients with > 2 years follow-up after PHPT diagnosis (2000-2018); 5244 patients (11.7%) were treated with parathyroidectomy. MAIN OUTCOMES MEASURE Clinically significant kidney stone event. RESULTS The cohort had a mean age of 66.0 years, was 87.8% male, and 66.4% White. Patients treated with parathyroidectomy had higher mean serum calcium (11.2 vs 10.8mg/dL) and were more likely to have a history of kidney stone events. Among patients with baseline history of kidney stones, the unadjusted incidence of ≥ 1 kidney stone event was 30.5% in patients managed with parathyroidectomy (mean follow-up, 5.6 years) compared with 18.0% in those managed nonoperatively (mean follow-up, 5.0 years). Patients treated with parathyroidectomy had a higher adjusted hazard of recurrent kidney stone events (hazard ratio [HR], 1.98; 95% CI, 1.56-2.51); however, this association declined over time (parathyroidectomy × time: HR, 0.80; 95% CI, 0.73-0.87). CONCLUSION In this predominantly male cohort with PHPT, patients treated with parathyroidectomy continued to be at higher risk of kidney stone events in the immediate years after treatment than patients managed nonoperatively, although the adjusted risk of stone events declined with time, suggesting a benefit to surgical treatment.
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Affiliation(s)
- Carolyn D Seib
- Correspondence: Carolyn Dacey Seib, MD, MAS, Stanford University, 300 Pasteur Dr, H3680, Stanford, CA 94305, USA.
| | - Calyani Ganesan
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Katherine D Arnow
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Alan C Pao
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - John T Leppert
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Nicolas B Barreto
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Electron Kebebew
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Manjula Kurella Tamura
- Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, CA 94304, USA
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
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14
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Wilson R, Cuthbertson L, Kazis L, Sawatzky R. Measuring Health Status in Long-Term Residential Care: Adapting the Veterans RAND 12 Item Health Survey (VR-12©). Clin Gerontol 2022; 45:562-574. [PMID: 32299327 DOI: 10.1080/07317115.2020.1752347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Measuring the perceived mental and physical health status of older adults living in long-term residential care (LTRC) is central to patient-centered care. This study examined the qualitative content validity of the Veterans RAND 12 Item Health Survey (VR-12) for LTRC and, based on the findings, the authors developed an adapted version of the generic patient-reported outcome measure for this population.Methods: Content validity was evaluated in two steps: (1) initial resident feedback (n = 9) and research team consensus discussions and (2) cognitive interviews with residents (n = 18) and a research team consensus discussion. The cognitive interviews examined comprehension, acceptability, and relevance of the VR-12 items.Results: Two VR-12 items had limited acceptability in the LTRC setting, the reference to "work" in items was irrelevant to residents, and the lack of a frame of reference ("During the past week … ") impacted comprehension of several items.Conclusions: Study findings informed the development of an adapted version of the VR-12 for older adults living in Canadian LTRC homes and provided content validity evidence regarding its relevance and appropriateness for this population.Clinical implications: Measuring the health status of older adults living in LTRC can help to monitor changes in health status over time and support person-centered care.
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Affiliation(s)
- Rozanne Wilson
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- Patient-Centred Performance Measurement and Improvement, BC Ministry of Health/Providence Health Care, Vancouver, British Columbia, Canada.,British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Lewis Kazis
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA, USA
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Prodan CI, Batra A, Ungvari Z, Liotta EM. Stringent public health measures during COVID-19 across ischemic stroke care systems: the potential impact of patient perceptions on health care-seeking behaviors. GeroScience 2022; 44:1255-1262. [PMID: 35467316 PMCID: PMC9035971 DOI: 10.1007/s11357-022-00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Decreases in acute stroke presentations have been reported during the coronavirus disease 2019 (COVID-19) pandemic surges. A recent study by Bojti et al. (GeroScience. 2021;43:2231–2248) sought to understand the relationship of public health mandates in Hungary as they were implemented with acute ischemic stroke admissions and interventions during two separate COVID-19 waves. We sought to perform a similar analysis of changes in ischemic stroke care at two distinct medical institutions in the USA. Two separate institutions and systems of ischemic stroke care were evaluated through a regional comprehensive stroke center telestroke service and a Veterans Affairs (VA) inpatient stroke and neurorehabilitation service. Telestroke consultations in a single system in Chicago, IL, were significantly decreased during the first COVID-19 wave during severely restricted public health mandates (z-score < − 2), and were less depressed during a subsequent wave with less severe restrictions (z-score approaching − 1), which resembles findings in Hungary as reported by Bojti et al. In contrast, inpatient admissions during the first and second COVID-19 waves to a VA stroke and neurorehabilitation service in Oklahoma City remained unchanged. The Chicago and Hungary patterns of stroke presentations suggest that public perceptions, as informed by regional health mandates, might influence healthcare-seeking behavior. However, the VA experience suggests that specific patient populations may react differently to given public health mandates. These observations highlight that changes in stroke presentation during the COVID-19 pandemic may vary regionally and by patient population as well as by the severity of public health mandates implemented. Further study of COVID-19-related public health policies on acute stroke populations is needed to capture the long-term impact of such policies. Learning from the real-time impact of pandemic surges and public health policy on presentation of acute medical conditions, such as ischemic stroke, may prove valuable for designing effective policies in the future.
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Affiliation(s)
- Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Ayush Batra
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 1150, Chicago, IL, 60611, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Eric M Liotta
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 1150, Chicago, IL, 60611, USA.
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16
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Health-Related Quality of Life by Gulf War Illness Case Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084425. [PMID: 35457293 PMCID: PMC9026791 DOI: 10.3390/ijerph19084425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
This study examines how health-related quality of life (HRQOL) and related indices vary by Gulf War illness (GWI) case status. The study population included veterans from the Gulf War Era Cohort and Biorepository (n = 1116). Outcomes were physical and mental health from the Veterans RAND 12 and depression, post-traumatic stress (PTSD), sleep disturbance, and pain. Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions were used. Kansas GWI derived subtypes included GWI (met symptom criteria; no exclusionary conditions (KS GWI: Sym+/Dx−)) and those without GWI: KS noncase (1): Sym+/Dx+, KS noncase (2): Sym−/Dx+, and noncase (3): Sym−/Dx−. CDC-derived subtypes included CDC GWI severe, CDC GWI mild-to-moderate and CDC noncases. Case status and outcomes were examined using multivariable regression adjusted for sociodemographic and military-related characteristics. Logistic regression analysis was used to examine associations between GWI case status and binary measures for depression, PTSD, and severe pain. The KS GWI: Sym+/Dx− and KS noncase (1): Sym+/Dx+ groups had worse mental and physical HRQOL outcomes than veterans in the KS noncase (2): Sym−/Dx+ and KS noncase (3): Sym−/Dx− groups (ps < 0.001). Individuals who met the CDC GWI severe criteria had worse mental and physical HRQOL outcomes than those meeting the CDC GWI mild-to-moderate or CDC noncases (ps < 0.001). For other outcomes, results followed a similar pattern. Relative to the less symptomatic comparison subtypes, veterans who met the Kansas symptom criteria, regardless of exclusionary conditions, and those who met the CDC GWI severe criteria experienced lower HRQOL and higher rates of depression, PTSD, and severe pain.
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17
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George EL, Massarweh NN, Youk A, Reitz KM, Shinall MC, Chen R, Trickey AW, Varley PR, Johanning J, Shireman PK, Arya S, Hall DE. Comparing Veterans Affairs and Private Sector Perioperative Outcomes After Noncardiac Surgery. JAMA Surg 2022; 157:231-239. [PMID: 34964818 PMCID: PMC8717209 DOI: 10.1001/jamasurg.2021.6488] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Recent legislation facilitates veterans' ability to receive non-Veterans Affairs (VA) surgical care. However, contemporary data comparing the quality and safety of VA and non-VA surgical care are lacking. Objective To compare perioperative outcomes among veterans treated in VA hospitals with patients treated in private-sector hospitals. Design, Setting, and Participants This cohort study took place across 8 noncardiac specialties in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) and American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 1, 2015, through December 31, 2018. Multivariable log-binomial modeling was used to evaluate the association between VA vs private sector care settings and 30-day mortality. Unmeasured confounding was quantified using the E-value. Patients 18 years and older undergoing a noncardiac procedures were included. Exposures Surgical care in either a VA or private sector setting. Main Outcomes and Measures Primary outcome was 30-day postoperative mortality. Secondary outcome was failure to rescue, defined as a postoperative death after a complication. Results Of 3 910 752 operations (3 174 274 from NSQIP and 736 477 from VASQIP), 1 498 984 (92.1%) participants in NSQIP were male vs 678 382 (47.2%) in VASQIP (mean difference, -0.449 [95% CI, -0.450 to -0.448]; P < .001), and 441 894 (60.0%) participants in VASQIP were frail or very frail vs 676 525 (21.3%) in NSQIP (mean difference, -0.387 [95% CI, -0.388 to -0.386]; P < .001). Overall, rates of 30-day mortality, complications, and failure to rescue were 0.8%, 9.5%, and 4.7%, respectively, in NSQIP (n = 3 174 274 operations) and 1.1%, 17.1%, and 6.7%, respectively in VASQIP (736 477) (differences in proportions, -0.003 [95% CI, -0.003 to -0.002]; -0.076 [95% CI, -0.077 to -0.075]; 0.020 [95% CI, 0.018-0.021], respectively; P < .001). Compared with private sector care, VA surgical care was associated with a lower risk of perioperative death (adjusted relative risk, 0.59 [95% CI, 0.47-0.75]; P < .001). This finding was robust in multiple sensitivity analyses performed, including among patients who were frail and nonfrail, with or without complications, and undergoing low and high physiologic stress procedures. These findings were also consistent when year was included as a covariate and in nonparsimonious modeling for patient-level factors. Compared with private sector care, VA surgical care was also associated with a lower risk of failure to rescue (adjusted relative risk, 0.55 [95% CI, 0.44-0.68]). An unmeasured confounder (present disproportionately in NSQIP data) would require a relative risk of 2.78 [95% CI, 2.04-3.68] to obviate the main finding. Conclusions and Relevance VA surgical care is associated with lower perioperative mortality and decreased failure to rescue despite veterans having higher-risk characteristics. Given the unique needs and composition of the veteran population, health policy decisions and budgetary appropriations should reflect these important differences.
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Affiliation(s)
- Elizabeth L. George
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California,Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California,Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California
| | - Nader N. Massarweh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ada Youk
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine M. Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Myrick C. Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rui Chen
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California
| | - Amber W. Trickey
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California
| | | | - Jason Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha,Nebraska Western Iowa Veterans Affairs Health System, Omaha
| | - Paula K. Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio,South Texas Veterans Health Care System, San Antonio
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California,Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California,Surgical Service Line, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Daniel E. Hall
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania,Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,Geriatric Research Educational and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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18
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Quach LT, Cho K, Driver JA, Ward R, Spiro A, Dugan E, Gaziano MJ, Djousse L, Rudolph JL, Gagnon DR. Social Characteristics, Health, and Mortality Among Male Centenarians Using Veterans Affairs (VA) Health Care. Res Aging 2022; 44:136-143. [PMID: 33779393 PMCID: PMC10756333 DOI: 10.1177/01640275211000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We studied male centenarian Veterans using VA health care to understand the impact of social characteristics on their annual mortality rate, adjusting for prevalent health conditions. This longitudinal study used VA Electronic Health Record data from 1997 to 2012 (n = 1,858). Covariates included age, race, marital status, and periods of military service. The mean age was 100.4 ± 1.4 years, 76% were white, and 49% were married. The average annual mortality rate was 32 per 100 person-years. The annual mortality rate was stable and not affected by race but did vary by marital status. Divorced or separated centenarians had a 21% higher rate of death than married centenarians. A diagnosis of dementia or of congestive heart failure each increased the mortality risk by 37%. Providers should consider prevalent health conditions, as well as marital status, in managing care of centenarian Veterans.
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Affiliation(s)
- Lien T. Quach
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Department of Gerontology, The University of Massachusetts Boston, MA, USA
- Providence VA Medical Center, Providence, RI, USA
| | - Kelly Cho
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jane A. Driver
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Providence VA Medical Center, Providence, RI, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel Ward
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Avron Spiro
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Brown University, Providence, RI, USA
| | - Elizabeth Dugan
- Department of Gerontology, The University of Massachusetts Boston, MA, USA
| | - Michael J. Gaziano
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Luc Djousse
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James L. Rudolph
- Providence VA Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - David R. Gagnon
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Brown University, Providence, RI, USA
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19
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Singh JA, Nelson DB, Nichol KL. Recent health-related quality of life, but not change, predicted mortality and healthcare utilization. J Clin Epidemiol 2021; 140:13-21. [PMID: 34433010 DOI: 10.1016/j.jclinepi.2021.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess whether change in HRQOL over a seven-year period was associated with subsequent mortality and hospitalization, after adjusting for important covariates, in a cohort of U.S. Veterans. METHODS We used data from a cohort of Veterans who completed a HRQOL survey in 1998 (Short-Form 36 for Veterans [SF-36V]) and a 2006 follow-up (SF-12V) HRQOL survey and SF12V scores were calculated at both time-points. We used logistic regression analyses to model the relationship between changes in the SF12-V physical component (PCS) and mental health component (MCS) scores and 1-year hospitalization and 1-year and 3.3-year mortality after the 2006 follow-up survey. RESULTS 13,900 participants provided data for both the initial and follow-up surveys. We found no significant associations between changes in PCS or MCS and one-year hospitalization after adjusting for follow-up HRQOL and other covariates. We found significant but relatively weak associations between changes in MCS and our mortality outcomes. CONCLUSION Given the follow-up MCS and PCS, change in PCS over the previous 7 years added little information for predicting mortality and hospitalization Although the change in MCS added some information for predicting mortality. Therefore, knowledge of patient's current HRQOL generally provides meaningful information for predicting subsequent mortality and hospitalization.
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Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical Center, Birmingham, AL 35294; Department of Medicine at School of Medicine; Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022.
| | - David B Nelson
- Minneapolis VAHCS, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN 55121
| | - Kristin L Nichol
- Department of Medicine, University of Minnesota, Minneapolis, MN 55121
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20
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Liberato ACS, Raitt MH, Zarraga IGE, MacMurdy KS, Dougherty CM. Health-Related Quality of Life in the Spironolactone to Reduce ICD Therapy (SPIRIT) Trial. Clin Nurs Res 2021; 31:588-597. [PMID: 34362264 DOI: 10.1177/10547738211036817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To describe health related quality of life (HRQOL) and symptoms in the SPIRIT trial and determine effects of implantable cardioverter defibrillator (ICD) shocks on HRQOL over 24 months. Ninety participants aged 66 ± 10 years, 96% men, 75% with NYHA class II, with an ICD were randomized to spironolactone 25 mg (N = 44) or placebo (N = 46). HRQOL was measured every 6 months for 24 months using: Patient Concerns Assessment (PCA), Short Form Health Survey-Veterans Version (SF-36V), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear mixed modeling compared changes in HRQOL over-time and ANCOVA compared HRQOL between those getting an ICD shock or not. Over 24-months, there were no differences in HRQOL between the spironolactone versus placebo groups. Those with at least one ICD shock reported significantly lower HRQOL and more symptoms at 6- and 24-months. Patients receiving one or more ICD shocks reported significant reductions in HRQOL and higher symptoms.
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Affiliation(s)
| | - Merritt H Raitt
- VA Portland Health Care System, OR, USA.,Oregon Health and Science University, Portland, USA
| | | | - Karen S MacMurdy
- VA Portland Health Care System, OR, USA.,Oregon Health and Science University, Portland, USA
| | - Cynthia M Dougherty
- University of Washington, Seattle, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
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21
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Makridis CA, Strebel T, Marconi V, Alterovitz G. Designing COVID-19 mortality predictions to advance clinical outcomes: Evidence from the Department of Veterans Affairs. BMJ Health Care Inform 2021; 28:bmjhci-2020-100312. [PMID: 34108143 PMCID: PMC8190987 DOI: 10.1136/bmjhci-2020-100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022] Open
Abstract
Using administrative data on all Veterans who enter Department of Veterans Affairs (VA) medical centres throughout the USA, this paper uses artificial intelligence (AI) to predict mortality rates for patients with COVID-19 between March and August 2020. First, using comprehensive data on over 10 000 Veterans’ medical history, demographics and lab results, we estimate five AI models. Our XGBoost model performs the best, producing an area under the receive operator characteristics curve (AUROC) and area under the precision-recall curve of 0.87 and 0.41, respectively. We show how focusing on the performance of the AUROC alone can lead to unreliable models. Second, through a unique collaboration with the Washington D.C. VA medical centre, we develop a dashboard that incorporates these risk factors and the contributing sources of risk, which we deploy across local VA medical centres throughout the country. Our results provide a concrete example of how AI recommendations can be made explainable and practical for clinicians and their interactions with patients.
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Affiliation(s)
- Christos A Makridis
- National Artificial Intelligence Institute at the Department of Veterans Affairs, US Department of Veterans Affairs, Washington, District of Columbia, USA .,Digital Economy Lab, Stanford University, Stanford University, Stanford, California, USA
| | - Tim Strebel
- Washington D.C. VA Medical Center, Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Vincent Marconi
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gil Alterovitz
- National Artificial Intelligence Institute at the Department of Veterans Affairs, US Department of Veterans Affairs, Washington, District of Columbia, USA.,Harvard Medical School, Boston, Massachusetts, USA
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22
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Soerensen SJC, Thomas IC, Schmidt B, Daskivich TJ, Skolarus TA, Jackson C, Osborne TF, Chertow GM, Brooks JD, Rehkopf DH, Leppert JT. Using an Automated Electronic Health Record Score To Estimate Life Expectancy In Men Diagnosed With Prostate Cancer In The Veterans Health Administration. Urology 2021; 155:70-76. [PMID: 34139251 DOI: 10.1016/j.urology.2021.05.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine if an automatically calculated electronic health record score can estimate intermediate-term life expectancy in men with prostate cancer to provide guideline concordant care. METHODS We identified all men (n = 36,591) diagnosed with prostate cancer in 2013-2015 in the VHA. Of the 36,591, 35,364 (96.6%) had an available Care Assessment Needs (CAN) score (range: 0-99) automatically calculated in the 30 days prior to the date of diagnosis. It was designed to estimate short-term risks of hospitalization and mortality. We fit unadjusted and multivariable Cox proportional hazards regression models to determine the association between the CAN score and overall survival among men with prostate cancer. We compared CAN score performance to two established comorbidity measures: The Charlson Comorbidity Index and Prostate Cancer Comorbidity Index (PCCI). RESULTS Among 35,364 men, the CAN score correlated with overall stage, with mean scores of 46.5 ( ± 22.4), 58.0 ( ± 24.4), and 68.1 ( ± 24.3) in localized, locally advanced, and metastatic disease, respectively. In both unadjusted and adjusted models for prostate cancer risk, the CAN score was independently associated with survival (HR = 1.23 95%CI 1.22-1.24 & adjusted HR = 1.17 95%CI 1.16-1.18 per 5-unit change, respectively). The CAN score (overall C-Index 0.74) yielded better discrimination (AUC = 0.76) than PCCI (AUC = 0.65) or Charlson Comorbidity Index (AUC = 0.66) for 5-year survival. CONCLUSION The CAN score is strongly associated with intermediate-term survival following a prostate cancer diagnosis. The CAN score is an example of how learning health care systems can implement multi-dimensional tools to provide fully automated life expectancy estimates to facilitate patient-centered cancer care.
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Affiliation(s)
- Simon John Christoph Soerensen
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Bogdana Schmidt
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Ted A Skolarus
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Ann Arbor, MI
| | - Christian Jackson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Glenn M Chertow
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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23
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Buchholz I, Feng YS, Buchholz M, Kazis LE, Kohlmann T. Translation and adaptation of the German version of the Veterans Rand-36/12 Item Health Survey. Health Qual Life Outcomes 2021; 19:137. [PMID: 33947411 PMCID: PMC8097879 DOI: 10.1186/s12955-021-01722-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The translated and culturally adapted German version of the Veterans Rand 36 Items Health Survey (VR-36), and its short form, the VR-12 counterpart, were validated in a German sample of orthopedic (n = 399) and psychosomatic (n = 292) inpatient rehabilitation patients. METHODS The instruments were analyzed regarding their acceptance, distributional properties, validity, responsiveness and ability to discriminate between groups by age, sex and clinically specific groups. Eligible study participants completed the VR-36 (n = 169) and the VR-12 (n = 177). They also completed validated patient-reported outcome measures (PROs) including the Euroqol-5 Dimensions 5 Level (EQ-5D-5L); Depression, Anxiety and Stress Scale (DASS); Hannover Functional Abilities Questionnaire (HFAQ); and CDC Healthy Days. The VR-12 and the VR-36 were compared to the reference instruments MOS Short Form-12 Items Health Survey (SF-12) version 1.0 and MOS Short Form-36 Items Health Survey (SF-36) version 1.0, using percent of completed items, distributional properties, correlation patterns, distribution measures of known groups validity, and effect size measures. RESULTS Item non-response varied between 1.8%/1.1% (SFVR-36/RESF-36) and 6.5%/8.6% (GHVR-36/GHSF-36). PCS was normally distributed (Kolmogorov-Smirnov tests: p > 0.05) with means, standard deviations and ranges very similar between SF-36 (37.5 ± 11.7 [13.8-66.1]) and VR-36 (38.5 ± 10.1 [11.7-67.8]), SF-12 (36.9 ± 10.9 [15.5-61.6]) and VR-12 (36.2 ± 11.5 [12.7-59.3]). MCS was not normally distributed with slightly differing means and ranges between the instruments (MCSVR-36: 36.2 ± 14.2 [12.9-66.6], MCSSF-36: 39.0 ± 15.6 [2.0-73.2], MCSVR-12: 37.2 ± 13.8 [8.4-70.2], MCSSF-12: 39.0 ± 12.3 [17.6-65.4]). Construct validity was established by comparing correlation patterns of the MCSVR and PCSVR with measures of physical and mental health. For both PCSVR and MCSVR there were moderate (≥ 0.3) to high (≥ 0.5) correlations with convergent (PCSVR: 0.55-0.76, MCSVR: 0.60-0.78) and small correlations (< 0.1) with divergent (PCSVR: < 0.12, MCSVR: < 0.16) self-report measures. Known-groups validity was demonstrated for both VR-12 and VR-36 (MCS and PCS) via comparisons of distribution parameters with significant higher mean PCS and MCS scores in both VR instruments found in younger patients with fewer sick days in the last year and a shorter duration of rehabilitation. CONCLUSIONS The psychometric analysis confirmed that the German VR is a valid and reliable instrument for use in orthopedic and psychosomatic rehabilitation. Yet further research is needed to evaluate its usefulness in other populations.
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Affiliation(s)
- Ines Buchholz
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - You-Shan Feng
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Maresa Buchholz
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, School of Public Health, Boston University, 715 Albany St Talbot Building, Boston, MA 02118 USA
| | - Thomas Kohlmann
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
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24
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Kulwin R, Watson TS, Rigby R, Coetzee JC, Vora A. Traditional Modified Broström vs Suture Tape Ligament Augmentation. Foot Ankle Int 2021; 42:554-561. [PMID: 33491480 DOI: 10.1177/1071100720976071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB. METHODS Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm. RESULTS Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST (P < .001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL (P = .14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group (P = .12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group (P = .144). CONCLUSION Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Robert Kulwin
- Illinois Bone and Joint Institute, Libertyville, IL, USA
| | | | - Ryan Rigby
- Logan Regional Orthopedics, Logan, UT, USA
| | | | - Anand Vora
- Illinois Bone and Joint Institute, Libertyville, IL, USA
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25
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Makridis CA, Zhao DY, Bejan CA, Alterovitz G. Leveraging machine learning to characterize the role of socio-economic determinants on physical health and well-being among veterans. Comput Biol Med 2021; 133:104354. [PMID: 33845269 DOI: 10.1016/j.compbiomed.2021.104354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/07/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION We investigate the contribution of demographic, socio-economic, and geographic characteristics as determinants of physical health and well-being to guide public health policies and preventative behavior interventions (e.g., countering coronavirus). METHODS We use machine learning to build predictive models of overall well-being and physical health among veterans as a function of these three sets of characteristics. We link Gallup's U.S. Daily Poll between 2014 and 2017 over a range of demographic and socio-economic characteristics with zipcode characteristics from the Census Bureau to build predictive models of overall and physical well-being. RESULTS Although the predictive models of overall well-being have weak performance, our classification of low levels of physical well-being performed better. Gradient boosting delivered the best results (80.2% precision, 82.4% recall, and 80.4% AUROC) with perceptions of purpose in the workplace and financial anxiety as the most predictive features. Our results suggest that additional measures of socio-economic characteristics are required to better predict physical well-being, particularly among vulnerable groups, like veterans. CONCLUSION Socio-economic characteristics explain large differences in physical and overall well-being. Effective predictive models that incorporate socio-economic data will provide opportunities to create real-time and personalized feedback to help individuals improve their quality of life.
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Affiliation(s)
- Christos A Makridis
- Stanford University Digital Economy Lab, and National Artificial Intelligence Institute at the Department of Veterans Affairs, 810 Vermont Ave NW, Washington, DC 20420, USA.
| | - David Y Zhao
- Department of Computer Science at Stanford University, Gates Computer Science Building, 353 Jane Stanford Way, Stanford, CA 94305, USA.
| | - Cosmin A Bejan
- Department Biomedical Informatics at Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.
| | - Gil Alterovitz
- Harvard Medical School, Boston Children's Hospital, National Artificial Intelligence Institute at the Department of Veterans Affairs, 810 Vermont Ave NW, Washington, DC 20420, USA.
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26
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McNett S, Lind MJ, Brown RC, Hawn S, Berenz EC, Brown E, McDonald SD, Pickett T, Danielson CK, Thomas S, Amstadter AB. Sleep Quality Moderates the Relationship between Anxiety Sensitivity and PTSD Symptoms in Combat-exposed Veterans. Behav Sleep Med 2021; 19:208-220. [PMID: 32063030 DOI: 10.1080/15402002.2020.1726749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Posttraumatic stress disorder (PTSD) and related conditions (e.g., depression) are common in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. High anxiety sensitivity (AS), defined as fear of anxiety and anxiety-related consequences, is related to greater PTSD and depressive symptoms; however, few studies have identified possible modifiers of these associations. The current study examined the moderating role of sleep quality in the associations between AS and PTSD and depressive symptoms. Participants: Participants were 155 OEF/OIF/OND community veterans ages 21-40 (12.3% women). Methods: Participants completed a semi-structured clinical interview for DSM-IV PTSD symptoms (Clinician Administered PTSD Scale; CAPS) and self-report measures of anxiety sensitivity (Anxiety Sensitivity Index), sleep quality (Pittsburgh Sleep Quality Index global score; PSQI), and depressive symptoms (Beck Depression Inventory-II; BDI-II). Results: Results of hierarchical linear regression models indicated that the main effects of AS and global PSQI score were significantly associated with greater PTSD and depressive symptoms (both with sleep items removed), above and beyond the covariates of trauma load and military rank. Sleep quality moderated the relationship between AS and PTSD symptoms (but not depressive symptoms), such that greater AS was associated with greater PTSD symptoms for individuals with good sleep quality, but not poor sleep quality. Conclusions: Sleep quality and AS account for unique variance in PTSD and depressive symptoms in combat-exposed veterans. AS may be less relevant to understanding risk for PTSD among combat-exposed veterans experiencing poor sleep quality.
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Affiliation(s)
- Sage McNett
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Mackenzie J Lind
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Ruth C Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Sage Hawn
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Erin C Berenz
- Department of Psychology, University of Illinois at Chicago , Illinois
| | - Emily Brown
- Dornsife School of Public Health, Drexel University , Philadelphia, Pennsylvania
| | - Scott D McDonald
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Treven Pickett
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Suzanne Thomas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Ananda B Amstadter
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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27
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Jenkins NW, Parrish JM, Nolte MT, Hrynewycz NM, Brundage TS, Singh K. Validating the VR-12 Physical Function Instrument After Anterior Cervical Discectomy and Fusion with SF-12, PROMIS, and NDI. HSS J 2020; 16:443-451. [PMID: 33380979 PMCID: PMC7749899 DOI: 10.1007/s11420-020-09817-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Development and validation of Veterans RAND 12-item (VR-12) physical component survey (PCS) has been established among civilian and veteran populations but it has not been examined among anterior cervical discectomy and fusion (ACDF) patients. PURPOSES/QUESTIONS We sought to validate legacy patient-reported outcome measures (PROMs) with VR-12 PCS among patients undergoing ACDF procedures. METHODS A prospectively collected surgical registry was retrospectively evaluated for elective single or multi-level ACDFs performed for degenerative spinal pathologies from January 2014 to August 2019. Exclusion criteria included missing pre-operative surveys and surgery for trauma, metastasis, or infection. Demographic variables, baseline pathologies, and peri-operative variables were collected. A paired t test evaluated the change from the pre-operative score to each post-operative timepoint for VR-12 PCS, the 12-item Short-Form Survey (SF-12) PCS, Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), and Neck Disability Index (NDI). Minimal clinically important difference (MCID) achievement was calculated at each timepoint. Correlation was evaluated with a Pearson's correlation coefficient and time-independent partial correlation. RESULTS Of the 202 patients who underwent ACDF, 41.1% were female and the average age was 49.5 years. All PROMs had statistically significantly increased from baseline when compared with post-operative timepoints (12 weeks, 6 months, 1 year, and 2 years). MCID achievement rates increased through 2 years. All timepoints revealed strong VR-12 PCS correlations with SF-12 PCS, PROMIS-PF, and NDI scores. CONCLUSION VR-12 PCS was strongly correlated with the well-validated SF-12 PCS and NDI metrics as well as with the more recent PROMIS-PF. All PROMs demonstrated statistically significant improvement in patients post-operatively. VR-12 PCS is a valid measure of physical function among patients undergoing ACDF.
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Affiliation(s)
- Nathaniel W. Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - James M. Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Michael T. Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Nadia M. Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Thomas S. Brundage
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
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Rogal SS, Yakovchenko V, Gonzalez R, Park A, Lamorte C, Gibson SP, Chartier M, Ross D, Comstock E, Bajaj JS, Morgan TR. Characterizing patient-reported outcomes in veterans with cirrhosis. PLoS One 2020; 15:e0238712. [PMID: 32915828 PMCID: PMC7485762 DOI: 10.1371/journal.pone.0238712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023] Open
Abstract
Background and aims The Veterans Health Administration (VA) cares for over 80,000 Veterans with cirrhosis annually. Given the importance of understanding patient reported outcomes in this complex population, we aimed to assess the associations between attitudes towards care, disease knowledge, and health related quality of life (HRQoL) in a national sample. Methods In this cross-sectional study, we mailed paper surveys to a random sample of Veterans with cirrhosis, oversampling those with decompensated disease. Surveys included the Veterans RAND 12-Item Health Survey (measuring HRQoL) and questions about demographics, characteristics of care, satisfaction with care (“attitudes towards care”), and symptoms of cirrhosis. Those who reported being “unsure” about whether they had decompensation events were defined as “unsure about cirrhosis symptoms” (“disease knowledge”). We used multivariable regression models to assess the factors associated with HRQoL. Results Of 1374 surveys, 551 (40%) completed surveys were included for analysis. Most Veterans (63%) were “satisfied” or “very satisfied” with VA liver care. Patients often self-reported being unsure about whether they had experienced hepatic decompensation events (34%). Overall average physical (PCS) and mental (MCS) component scores of HRQoL were 30±11 and 41±12. In multivariable regression models, hepatic decompensation (PCS:β = -3.8, MCS:β = -2.2), medical comorbidities (β = −-2.0, β = -1.7), and being unsure about cirrhosis symptoms (β = -1.9, β = -3.3) were associated with worse HRQoL, while age (β = 0.1, β = 0.2) and satisfaction with care (β = 0.6; β = 1.6) were associated with significantly better HRQoL. Conclusions Hepatic decompensation, lower satisfaction with care, and being unsure about cirrhosis symptoms were associated with reduced QOL scores in this national cohort.
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Affiliation(s)
- Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
- Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: ,
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Edith Norse Rogers Memorial VA Hospital, Bedford, Massachusetts, United States of America
| | - Rachel Gonzalez
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, United States of America
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare Transformation, Washington, DC, United States of America
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
| | - Sandra P. Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
| | - Maggie Chartier
- Veterans Health Administration, HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Washington, DC, United States of America
| | - David Ross
- Veterans Health Administration, HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Washington, DC, United States of America
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Gastroenterology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, United States of America
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, United States of America
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Nayfe R, Chansard M, Hynan LS, Mortensen EM, Annaswamy T, Fraenkel L, Makris UE. Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain. BMC Musculoskelet Disord 2020; 21:598. [PMID: 32900386 PMCID: PMC7487821 DOI: 10.1186/s12891-020-03587-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. Identifying efficient and reliable patient reported outcome measures is critical for research and clinical purposes. The NIH's Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated "legacy" instruments in older adults with cLBP. This study evaluates construct (convergent and discriminant) validity and time to complete (TTC) PROMIS as compared to legacy instruments. METHODS We enrolled older Veterans (age 60+) with cLBP with/without leg pain scheduled for lumbar epidural steroid injections. Subjects completed PROMIS computer adaptive test item banks and corresponding legacy instruments in the following domains: pain intensity, interference, and behavior; functional status; depression and anxiety; fatigue; sleep and social functioning. Convergent and discriminant validity between PROMIS and legacy instruments was evaluated using Spearman rank order correlations; Mann-Whitney U tests compared TTC. RESULTS Of the 71 Veterans recruited, the median (IQR) age was 67 (63-71) years old, 94% were men, 76% were White, 17% Black, and 96% were Non-Hispanic. Spearman correlations between PROMIS and legacy instruments showed moderate to very strong convergent validity in all domains (r = 0.4-1.0), except for social functioning and pain behavior (PROMIS Pain Behavior with Fear Avoidance Belief Questionnaire). The total median TTC for all PROMIS items was significantly shorter than legacy items, 8 min 50 s vs 29 min 14 s respectively, p < 0.001. CONCLUSIONS Given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional PROs in older Veterans with cLBP for both research and clinical purposes.
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Affiliation(s)
- Rabih Nayfe
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA
| | | | - Linda S Hynan
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Psychiatry, UTSW, Dallas, TX, USA
| | - Eric M Mortensen
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Medicine, University of Connecticut, Farmington, CT, USA
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA
| | - Thiru Annaswamy
- Department of Physical Medicine & Rehabilitation, VA North Texas Health Care System, Dallas, TX, USA
| | - Liana Fraenkel
- Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA.
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA.
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA.
- Department of Internal Medicine, Division of Rheumatic Diseases, VA North Texas Health Care System, 4500 S Lancaster Rd., Dallas, TX, 75216, USA.
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Stolzmann K, Meterko M, Miller CJ, Belanger L, Seibert MN, Bauer MS. Survey Response Rate and Quality in a Mental Health Clinic Population: Results from a Randomized Survey Comparison. J Behav Health Serv Res 2020; 46:521-532. [PMID: 29948573 DOI: 10.1007/s11414-018-9617-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Given the limited ability of informatics-based assessment technologies to reach individuals with serious mental health conditions, this study evaluated the feasibility and data quality of mail-out healthcare surveys in this population to assist in measure selection for a multi-site controlled implementation trial. Veterans were randomly selected from those who had received services at a mental health clinic in the Department of Veterans Affairs, and were randomly assigned to one of three questionnaire lengths. Survey length (48-127 items) was not associated with differences in response rate, percent of items missing, or data quality. However, internal consistency reliability was variable among scales and survey lengths. Additional analyses indicate the above measures of survey data quality may differ among respondents who are non-white and younger and have psychotic disorders. These results can inform survey protocols to ensure maximal representation of this vulnerable population in health planning and policy assessment.
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Affiliation(s)
- Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, (152M), Boston, MA, 02130, USA.
| | - Mark Meterko
- Performance Measurement, VHA Office of Analytics and Business Intelligence (OABI), ENRM Veterans Affairs Medical Center, 200 Springs Road, Bedford, MA, 01730, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health and Management, Boston, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, (152M), Boston, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Lindsay Belanger
- Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239-3098, USA
| | - Marjorie Nealon Seibert
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, (152M), Boston, MA, 02130, USA
| | - Mark S Bauer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, (152M), Boston, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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Abstract
OBJECTIVES There are still unanswered questions about the best treatment options for ankle arthritis after severe lower leg trauma. This study compared results in outcomes and complications for 3 groups. DESIGN Retrospective cohort study case-control study. SETTING Single institution. PATIENTS Three groups of 100 surgeries. INTERVENTION Patients underwent an ankle fusion using anterior plate, total ankle arthroplasty (TAA) for primary osteoarthritis (OA), or a TAA for post-traumatic arthritis (PTA). MAIN OUTCOME MEASUREMENTS Veterans Rand 12-Item Health Survey (VR-12), Ankle Osteoarthritis Scale, Visual Analog Pain Scale, and the American Orthopaedic Foot and Ankle Society Hindfoot score were collected preoperatively and at subsequent postoperative appointments. A patient satisfaction survey was also distributed to each patient postoperatively. RESULTS Although all scores improved from preoperative to latest postoperative, the total ankle for PTA consistently resulted in the best postoperative outcomes. Patient satisfaction survey indicated 26% of fusion, 55% of TAA-OA, and 63% of TAA-PTA experienced very good to excellent pain relief. The overall satisfaction was found to be 92.5% for the TAA-PTA patients, 90.5% for the TAA-OA patients, and 84% for the fusion patients. Revision surgeries included 2 from the TAA-OA group, 2 from the TAA-PTA group, and 1 fusion patient. CONCLUSIONS Results of comparing 3 groups who underwent an ankle fusion or a TAA demonstrate improvement in pain (P < 0.001), physical quality of life (P < 0.001), and activity (P < 0.001) and resulted in a high level of patient satisfaction. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Impact of Wartime Stress Exposures and Mental Health on Later-Life Functioning and Disability in Vietnam-Era Women Veterans: Findings From the Health of Vietnam-Era Women's Study. Psychosom Med 2020; 82:147-157. [PMID: 31714370 PMCID: PMC8845064 DOI: 10.1097/psy.0000000000000762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The effect of stress exposures and mental health sequelae on health-related outcomes is understudied among older women veterans. We examined a) the impact of wartime stress exposures on later-life functioning and disability in Vietnam-era women veterans and b) the extent to which mental health conditions known to be associated with stress-posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)-are associated with additional later-life functioning and disability. METHODS Data were collected in 2011 to 2012 using a mail survey and telephone interview of 4219 women veterans who were active duty during the Vietnam Era. Health functioning was assessed using the Veterans RAND 36-Item Health Survey, and disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Wartime exposures were assessed using the Women's War-Zone Stressor Scale-Revised; the Composite International Diagnostic Interview, version 3.0 was used to assess PTSD, MDD, and GAD. RESULTS Several wartime stress exposures-including job-related pressures, dealing with death, and sexual discrimination and harassment-were associated with worse later-life health (β ranges, -0.04 to -0.26 for functioning, 0.05 to 0.30 for disability). Current PTSD was linked with lower health functioning (physical, β = -0.06; mental, β = -0.15) and greater disability (β = 0.14). Current MDD and GAD were also associated with lower mental health functioning (MDD, β = -0.29; GAD, β = -0.10) and greater disability (MDD, β = 0.16; GAD, β = 0.06). CONCLUSIONS Results underscore the importance of detection and treatment of the potential long-term effects of wartime stressors and mental health conditions among women veterans.
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Morin RT, Li Y, Mackin RS, Whooley MA, Conwell Y, Byers AL. Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide. J Am Geriatr Soc 2019; 67:2553-2559. [PMID: 31469184 DOI: 10.1111/jgs.16126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. DESIGN Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012-2014). SETTING All VA medical centers in the United States. PARTICIPANTS A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. MEASUREMENTS Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records. RESULTS Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain-Osteoarthritis (30.1%); Depression-Chronic Pain (22.9%); Depression-Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms. CONCLUSION This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention. J Am Geriatr Soc 67:2553-2559, 2019.
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Affiliation(s)
- Ruth T Morin
- SFVAMC, San Francisco VA Health Care System, San Francisco, California
| | - Yixia Li
- SFVAMC, San Francisco VA Health Care System, San Francisco, California.,Northern California Institute for Research and Education, San Francisco, California
| | - R Scott Mackin
- SFVAMC, San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Mary A Whooley
- Department of Medicine (Division of Internal Medicine), University of California, San Francisco, California
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Amy L Byers
- SFVAMC, San Francisco VA Health Care System, San Francisco, California.,Department of Mental Health Service, University of California, San Francisco, California
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Drayer NJ, Wallace CS, Yu HH, Mansfield TD, Cummings DL, Hood DK, Arrington ED, Kang DG. High Resiliency Linked to Short-Term Patient Reported Outcomes and Return to Duty Following Arthroscopic Knee Surgery. Mil Med 2019; 185:112-116. [DOI: 10.1093/milmed/usz180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/02/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
Introduction
Resilience is a psychometric construct of a patient’s ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes.
Materials and Methods
We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran’s Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared.
Results
We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group.
Conclusions
Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.
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Affiliation(s)
- Nicholas J Drayer
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Christopher S Wallace
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Henry H Yu
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Taylor D Mansfield
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Danielle L Cummings
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Debra K Hood
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Edward D Arrington
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
| | - Daniel G Kang
- Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA
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Vega JF, Jacobs CA, Strnad GJ, Farrow L, Jones MH, Miniaci A, Parker RD, Rosneck J, Saluan P, Williams JS, Spindler KP. Prospective Evaluation of the Patient Acceptable Symptom State to Identify Clinically Successful Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:1159-1167. [PMID: 30883186 DOI: 10.1177/0363546519831008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The length of most patient-reported outcome measures creates significant response burden, which hampers follow-up rates. The Patient Acceptable Symptom State (PASS) is a single-item, patient-reported outcome measure that asks patients to consider all aspects of life to determine whether the state of their joint is satisfactory; this measure may be viable for tracking outcomes on a large scale. HYPOTHESIS The PASS question would identify clinically successful anterior cruciate ligament reconstruction (ACLR) at 1-year follow-up with high sensitivity and moderate specificity. We defined "clinically successful" ACLR as changes in preoperative to postoperative scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale and the KOOS knee-related quality of life subscale in excess of minimal clinically important difference or final KOOS pain or knee-related quality of life subscale scores in excess of previously defined PASS thresholds. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Patients enrolled in a prospective longitudinal cohort completed patient-reported outcome measures immediately before primary ACLR. At 1-year follow-up, patients completed the same patient-reported outcome measures and answered the PASS question: "Taking into account all the activity you have during your daily life, your level of pain, and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?" RESULTS A total of 555 patients enrolled in our cohort; 464 were eligible for this study. Of these, 300 patients (64.7%) completed 1-year follow-up, of whom 83.3% reported satisfaction with their knee after surgery. The PASS question demonstrated high sensitivity to identify clinically successful ACLR (92.6%; 95% CI, 88.4%-95.6%). The specificity of the question was 47.1% (95% CI, 35.1%-59.5%). The overall agreement between the PASS and our KOOS-based criteria for clinically successful intervention was 81.9%, and the kappa value indicated moderate agreement between the two methods (κ = 0.44). CONCLUSION The PASS question identifies individuals who have experienced clinically successful ACLR with high sensitivity. The limitation of the PASS is its low specificity, which we calculated to be 47.1%. Answering "no" to the PASS question meant that a patient neither improved after surgery nor achieved an acceptable final state of knee health. The brevity, interpretability, and correlation of the PASS question with significant improvements on various KOOS subscales make it a viable option in tracking ACLR outcomes on a national or global scale.
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Affiliation(s)
- José F Vega
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.,Cleveland Clinic Orthopaedics Department, Cleveland, Ohio, USA
| | - Cale A Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Kentucky Clinic, Lexington, Kentucky, USA
| | | | - Lutul Farrow
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - Morgan H Jones
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - Anthony Miniaci
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - Richard D Parker
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - James Rosneck
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - Paul Saluan
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - James S Williams
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Cleveland Clinic Orthopaedics Sports Health, Cleveland, Ohio, USA
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Cortes J, Fletcher TL, Latini DM, Kauth MR. Mental Health Differences Between Older and Younger Lesbian, Gay, Bisexual, and Transgender Veterans: Evidence of Resilience. Clin Gerontol 2019; 42:162-171. [PMID: 30321114 DOI: 10.1080/07317115.2018.1523264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine health and identity differences between older (50+) and younger (< 50) lesbian, gay, bisexual, and transgender (LGBT) veterans. METHODS Participants (N = 254) completed an internet survey assessing depression, anxiety, alcohol use, identity, minority stress, and outness. T tests and logistic regression were used to analyze results. RESULTS Older LGBT veterans reported less alcohol use (p < .01) than younger counterparts. No age differences in depression or anxiety were reported. Older participants reported LGBT identity as more central to their overall identity (p < .01) and having less minority stress (p < .05), than younger participants. CONCLUSIONS Compared to younger LGBT veterans, older LGBT veterans appeared more resilient over stressors that can impact mental health. Overall older LGBT veterans experienced less alcohol use and reported less minority stress than younger veterans. LGBT identity was more central to older veterans' overall identity than younger Veterans. CLINICAL IMPLICATIONS LGBT veterans may experience stressors that can impact mental health, although older LGBT veterans show remarkable resilience. Clinicians should assess sexual orientation and gender identity, as well as veteran status, of patients in order to best evaluate their health risks and strengths.
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Affiliation(s)
- Jose Cortes
- a Michael E. DeBakey VA Medical Center , Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety , Houston , Texas , USA.,b Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , Texas , USA
| | - Terri L Fletcher
- a Michael E. DeBakey VA Medical Center , Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety , Houston , Texas , USA.,b Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , Texas , USA.,c VA South Central Mental Illness Research, Education, and Clinical Center , Houston , Texas , USA.,d Scott Department of Urology , Baylor College of Medicine , Houston , Texas , USA
| | - David M Latini
- b Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , Texas , USA.,d Scott Department of Urology , Baylor College of Medicine , Houston , Texas , USA.,e Mental Health Care Line, Michael E. DeBakey VA Medical Center , Houston , Texas , USA.,f Montrose Center and Montrose Research Institute , Houston , Texas , USA
| | - Michael R Kauth
- a Michael E. DeBakey VA Medical Center , Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety , Houston , Texas , USA.,c VA South Central Mental Illness Research, Education, and Clinical Center , Houston , Texas , USA.,g Lesbian, Gay, Bisexual, and Transgender Health Program, Office of Patient Care Services, Veterans Health Administration , Washington, District of Columbia , USA
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Reducing Cancellations and Optimizing Surgical Scheduling of Ophthalmology Cases at a Veterans Affairs Medical Center. J Healthc Qual 2019; 41:83-90. [DOI: 10.1097/jhq.0000000000000187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huston JC, Iverson KM, Mitchell KS. Associations between healthcare use and disordered eating among female veterans. Int J Eat Disord 2018; 51:978-983. [PMID: 29846012 DOI: 10.1002/eat.22885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) have considerable medical and psychiatric comorbidity as well as increased healthcare use and associated costs. However, EDs remain largely undetected and understudied among veteran populations, and EDs are not routinely screened for or treated in Veterans Affairs (VA) medical settings. Research elucidating the links between disordered eating and VA and non-VA healthcare use is needed to inform policy and practice for ED screening and treatment. METHOD Data regarding probable EDs and VA and non-VA healthcare use was obtained through a mail survey of 198 female veterans receiving care from VA. RESULTS A total of 21 participants (10.6%) met probable criteria for subthreshold anorexia nervosa, bulimia nervosa, or binge-eating disorder. Negative binomial regression models revealed that female veterans with EDs reported higher frequency of VA mental healthcare use and substance use disorder treatment, above and beyond the association of comorbid PTSD and depression symptoms. DISCUSSION These findings confirm the high probability that female veterans with EDs are utilizing significant VA mental health resources. Screening for EDs may be particularly important in VA medical and mental health settings.
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Affiliation(s)
- J C Huston
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Department of Psychiatry, Harvard University Medical School, Boston, Massachusetts
| | - K M Iverson
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - K S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
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Xie S, Lin H, Meng Y, Zhu J, Zhang Y, Zhang L, Li G. Analysis and determinants of Chinese navy personnel health status: a cross-sectional study. Health Qual Life Outcomes 2018; 16:138. [PMID: 29996861 PMCID: PMC6042426 DOI: 10.1186/s12955-018-0961-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been very few studies analyzing the relationship of physical and mental health status with health behaviors and deployment status in Chinese navy personnel. Thus, we undertook this survey to assess this relationship and identify specific factors affecting the physical and mental health status. METHODS The subjects enrolled in this study were selected from four units of the active-duty navy personnel in China, based on a cluster random sampling design. A total of 1200 Chinese navy personnel participated and completed the questionnaire survey that included veteran SF-36 form and a self-designed questionnaire regarding their sociodemographic characteristics, deployment status, self-rated health status and health behaviors. Totally 1200 questionnaires were distributed to different participants, while 1083 valid questionnaires were included in the final analysis. All data were analyzed using SPSS18.0 software. RESULTS Based on the information provided by navy personnel, 17.82, 35.09 and 23.08% rated their health as excellent, very good and good, respectively. The mean score of physical component summary (PCS) and mental component summary (MCS) was 50.53 and 41.39, respectively. Length of service, binge drinking, regular drinking and BMI appeared to be associated with PCS score, while household income, binge drinking and BMI affected MCS score. Deployment status and smoking exhibited no significant association with PCS and MCS scores. CONCLUSIONS Our study suggested that the sociodemographic factors like length of service and household income, along with behavioral risk factors like binge drinking, regular drinking and body mass index (BMI), seem to affect the physical and mental health status of Chinese navy personnel. However, additional data collection and more detailed analysis would still be required to develop a systematic, comprehensive and corresponding health education program to promote overall health status.
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Affiliation(s)
- Shali Xie
- Department of Health Education, College of Military Preventive Medicine, Army Medical University, Chongqing, 400038 China
| | - Hui Lin
- Department of Tropical Epidemiology, College of Military Preventive Medicine, Army Medical University, Chongqing, 400038 China
| | - Yi Meng
- Department of Social Work, Social and Public Management School, Chongqing Technology and Business University, Chongqing, 400067 China
| | - Jundong Zhu
- Department of Nutrition and Food Hygiene, College of Military Preventive Medicine, Army Medical University, Chongqing, 400038 China
| | - Yanqi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Army Medical University, Chongqing, 400038 China
| | - Ling Zhang
- Department of Health Education, College of Military Preventive Medicine, Army Medical University, Chongqing, 400038 China
| | - Gaoming Li
- Department of Health Statistics, College of Military Preventive Medicine, Army Medical University, Chongqing, 400038 China
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Assessment of health-related quality of life in spine treatment: conversion from SF-36 to VR-12. Spine J 2018; 18:1292-1297. [PMID: 29501747 DOI: 10.1016/j.spinee.2018.02.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/02/2018] [Accepted: 02/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Health-related quality-of-life outcomes have been collected with the Medical Outcomes Study (MOS) Short Form 36 (SF-36) survey. Boston University School of Public Health has developed algorithms for the conversion of SF-36 to Veterans RAND 12-Item Health Survey (VR-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. PURPOSE The purpose of the present study is to investigate the conversion of the SF-36 to VR-12 PCS and MCS scores. STUDY DESIGN Preoperative and postoperative SF-36 were collected from patients who underwent lumbar or cervical surgery from a single surgeon between August 1998 and January 2013. METHODS Short Form 36 PCS and MCS scores were calculated following their original instructions. The SF-36 answers were then converted to VR-12 PCS and MCS scores following the algorithm provided by the Boston University School of Public Health. The mean score, preoperative to postoperative change, and proportions of patients who reach the minimum detectable change were compared between SF-36 and VR-12. RESULTS A total of 1,968 patients (1,559 lumbar and 409 cervical) had completed preoperative and postoperative SF-36. The values of the SF-36 and VR-12 mean scores were extremely similar, with score differences ranging from 0.77 to 1.82. The preoperative to postoperative improvement was highly significant (p<.001) for both SF-36 and VR-12 scores. The mean change scores were similar, with a difference of up to 0.93 for PCS and up to 0.37 for MCS. Minimum detectable change (MDC) values were almost identical for SF-36 and VR-12, with a difference of 0.12 for PCS and up to 0.41 for MCS. The proportions of patients whose change in score reached MDC were also nearly identical for SF-36 and VR-12. About 90% of the patients above SF-36 MDC were also above VR-12 MDC. CONCLUSIONS The converted VR-12 scores, similar to the SF-36 scores, detect a significant postoperative improvement in PCS and MCS scores. The calculated MDC values and the proportions of patients whose score improvement reach MDC are similar for both SF-36 and VR-12.
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Cotner BA, Ottomanelli L, O'Connor DR, Njoh EN, Barnett SD, Miech EJ. Quality of Life Outcomes for Veterans With Spinal Cord Injury Receiving Individual Placement and Support (IPS). Top Spinal Cord Inj Rehabil 2018; 24:325-335. [PMID: 30459495 DOI: 10.1310/sci17-00046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). Objective: To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Methods: Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. Results: At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. Conclusion: IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes.
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Affiliation(s)
- Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Anthropology, University of South Florida, Tampa, Florida
| | - Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, Florida
| | - Danielle R O'Connor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Eni N Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Scott D Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Edward J Miech
- VA HSR&D Center for Health Information & Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.,VA Health Services Research and Development (HSR&D) PRISM QUERI, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Emergency Medicine & Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Preoperative factors associated with worsening in health-related quality of life following coronary artery bypass grafting in the Randomized On/Off Bypass (ROOBY) trial. Am Heart J 2018; 198:33-38. [PMID: 29653645 DOI: 10.1016/j.ahj.2017.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/17/2017] [Indexed: 11/21/2022]
Abstract
For advanced coronary disease, coronary artery bypass graft (CABG) surgery generally improves patients' symptoms and long-term survival. Unfortunately, some patients experience worse health-related quality of life (HRQL) after CABG. The objective of this study is to report the frequency and risk factors associated with 1-year post-CABG HRQL deterioration. METHODS From 2002 to 2007, 2203 "Randomized On/Off Bypass" (ROOBY) trial patients randomly received either off-pump or on-pump CABG at 18 VA medical centers. Subjects completed both baseline and 1-year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36 (VR-36) questionnaires to assess HRQL. Using previously published criteria, the rates of clinically significant changes were determined for the SAQ [angina frequency (AF), physical limitation (PL), and quality of life (QoL)] and VR36 [mental component score (MCS) and physical component score (PCS)] subscales. Multivariate regression models were then used to identify pre-CABG patient characteristics associated with worsened 1-year HRQL status for each subscale. RESULTS Over 80% of patients had an improvement or no change in SAQ and VR-36 subscale scores 1 year after CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8% SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of 1-year HRQL deterioration were diabetes and smoking for the SAQ-AF; diabetes, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL; diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS. The baseline score was an independent predictor for worsening in all the subscales studied. CONCLUSIONS Among VA patients, less than 20% experienced worse HRQL 1 year after CABG. For patients with low symptom burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior stroke, clinicians should be more cautious in pre-CABG counseling as to their anticipated HRQL improvements.
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Epidemiology of lower extremity peripheral artery disease in veterans. J Vasc Surg 2018; 68:527-535.e5. [PMID: 29588132 PMCID: PMC6132057 DOI: 10.1016/j.jvs.2017.11.083] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022]
Abstract
Objective: The objective of this study was to describe the epidemiology, clinical features, outcomes, and predictors of mortality in veterans with peripheral artery disease (PAD). Methods: We used national data from the Veterans Health Administration from fiscal years 2009 to 2011 to identify patients with a new diagnosis of PAD. Within this cohort, we describe characteristics of the patients, use of recommended medications, and clinical outcomes during a 3-year follow-up (fiscal year 2014). We used Cox proportional hazards regression to examine predictors of mortality and adverse limb outcomes (amputation and hospitalization for critical limb ischemia [CLI]) during follow-up. Results: A total of 175,865 patients with a new diagnosis of PAD were included. The mean age was 69.9 years; 97.8% were male, and 67.7% were white. Nearly 77% of patients had hypertension, 46.5% had diabetes, 23% had chronic obstructive pulmonary disease, and 12.9% had renal failure. A prescription for statins was filled by 60.8%, and 34.9% received high-intensity statins within 90 days of PAD diagnosis. At 1 year, 2.6% underwent revascularization, 1.3% developed CLI, and 1.1% underwent amputation. During a median follow-up of 3.8 years, a total of 28.6% patients died (6.7% at 1 year), and 3.7% developed a limb outcome (2.0% at 1 year). Predictors of mortality included advanced age, comorbidities, and CLI or amputation at presentation. In contrast, prescription with statins was associated with lower mortality. Similar findings were present with regard to predictors of adverse limb outcomes, except that older age was associated with a lower risk of amputation or CLI. Conclusions: We found that veterans with PAD have a high prevalence of comorbid conditions and have a significant risk of mortality and limb loss. A substantial proportion of veterans with PAD are not prescribed recommended medications, especially statin therapy. Our data highlight important opportunities for improving care of veterans with PAD. (J Vasc Surg 2018; 68:527–35.)
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Zenk SN, Tarlov E, Powell LM, Wing C, Matthews SA, Slater S, Gordon HS, Berbaum M, Fitzgibbon ML. Weight and Veterans' Environments Study (WAVES) I and II: Rationale, Methods, and Cohort Characteristics. Am J Health Promot 2018; 32:779-794. [PMID: 29214851 PMCID: PMC5876028 DOI: 10.1177/0890117117694448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To present the rationale, methods, and cohort characteristics for 2 complementary "big data" studies of residential environment contributions to body weight, metabolic risk, and weight management program participation and effectiveness. DESIGN Retrospective cohort. SETTING Continental United States. PARTICIPANTS A total of 3 261 115 veterans who received Department of Veterans Affairs (VA) health care in 2009 to 2014, including 169 910 weight management program participants and a propensity score-derived comparison group. INTERVENTION The VA MOVE! weight management program, an evidence-based lifestyle intervention. MEASURES Body mass index, metabolic risk measures, and MOVE! participation; residential environmental attributes (eg, food outlet availability and walkability); and MOVE! program characteristics. ANALYSIS Descriptive statistics presented on cohort characteristics and environments where they live. RESULTS Forty-four percent of men and 42.8% of women were obese, whereas 4.9% of men and 9.9% of women engaged in MOVE!. About half of the cohort had at least 1 supermarket within 1 mile of their home, whereas they averaged close to 4 convenience stores (3.6 for men, 3.9 for women) and 8 fast-food restaurants (7.9 for men, 8.2 for women). Forty-one percent of men and 38.6% of women did not have a park, and 35.5% of men and 31.3% of women did not have a commercial fitness facility within 1 mile. CONCLUSION Drawing on a large nationwide cohort residing in diverse environments, these studies are poised to significantly inform policy and weight management program design.
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Affiliation(s)
- Shannon N Zenk
- 1 Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Elizabeth Tarlov
- 1 Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
- 2 Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL, USA
| | - Lisa M Powell
- 3 Health Policy and Administration Division, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
- 4 Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Coady Wing
- 5 Indiana University-Bloomington School of Public and Environmental Affairs, Bloomington, IN, USA
| | - Stephen A Matthews
- 6 Department of Sociology, Anthropology, and Demography, Pennsylvania State University, University Park, PA, USA
| | - Sandy Slater
- 3 Health Policy and Administration Division, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
- 4 Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Howard S Gordon
- 7 Jesse Brown VA Medical Center, Chicago, IL, USA
- 8 Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael Berbaum
- 4 Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian L Fitzgibbon
- 3 Health Policy and Administration Division, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
- 4 Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Coetzee JC, Ellington JK, Ronan JA, Stone RM. Functional Results of Open Broström Ankle Ligament Repair Augmented With a Suture Tape. Foot Ankle Int 2018; 39:304-310. [PMID: 29420055 DOI: 10.1177/1071100717742363] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Broström procedure is the most commonly used lateral ligament repair for chronic instability, but there is concern about the strength of the repair and the risk of reinjury. Currently, the InternalBraceTM ligament augmentation repair is an accepted augmentation method for management of a Broström procedure. Our hypothesis was that augmentation of the Broström repair with an InternalBraceTM would allow accelerated rehabilitation and return to activity and would aid in stability of the repair without a tendency to stretch. METHODS Eighty-one patients with lateral ankle instability procedures repaired with a Broström and InternalBraceTM augmentation were evaluated at a one-time postoperative visit between 6 and 24 months. Outcomes included demographics, surgical time, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, Veterans Rand 12-Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), Visual Analog Scale (VAS), satisfaction, and objective clinical measurements. Eighty-one patients were analyzed including 30 males and 51 females. Median age was 34 years (range, 18-62 years) with a median return for follow-up of 11.5 months (range, 6-27 months). RESULTS Average postoperative VAS and satisfaction were 0.8 ± 1.4 and 9.1 ± 1.6, respectively. Mean return to sport (n = 68) was 84.1 days. Average AOFAS Ankle-Hindfoot score was 94.3. A score of 90 or higher on the FAAM Sports subscale was seen in 79.0% of the subjects. The single-leg hop test (Limb Symmetry Index %) showed that 86.4% of patients returned to normal or near normal function. The tape measure method and ankle dorsiflexion comparisons showed a significant difference: 9.2 ± 3.3 cm (operative side) and 10.4 ± 3.7 cm (contralateral side) ( P = .034). Ankle plantar flexion comparison (goniometer) was 48.5 ± 11.5 degrees (operative side) and 49.7 ± 11.9 degrees (contralateral side), showing no difference ( P = .506). CONCLUSION These results suggest that InternalBraceTM augmentation of a Broström procedure is a safe and efficacious procedure that produces favorable outcomes in patients in terms of preventing recurrent instability in the ankle in the short term. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- J Chris Coetzee
- 1 Minnesota Orthopedic Sports Medicine Institute (MOSMI) at Twin Cities Orthopedics, Edina, MN, USA
| | | | | | - Rebecca M Stone
- 1 Minnesota Orthopedic Sports Medicine Institute (MOSMI) at Twin Cities Orthopedics, Edina, MN, USA
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McAndrew LM, Greenberg LM, Ciccone DS, Helmer DA, Chandler HK. Telephone-Based versus In-Person Delivery of Cognitive Behavioral Treatment for Veterans with Chronic Multisymptom Illness: A Controlled, Randomized Trial. MILITARY BEHAVIORAL HEALTH 2018; 6:56-65. [PMID: 31192051 PMCID: PMC6561490 DOI: 10.1080/21635781.2017.1337594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI). METHOD Veterans (N=128) who endorsed symptoms of CMI were randomized to: usual care (n=43), in-person (n=42) or telephone-delivered cognitive behavioral stress management (n=43). Assessments were conducted at baseline, three months, and twelve months. The primary outcome was limitation in roles at work and home (i.e., 'role physical'). Reductions in catastrophizing cognitions were evaluated as a mechanism of action. RESULTS Intent-to-treat analyses showed no statistically significant main effect (F(2, 164)=.58, p=.56) or interaction effect (F(4,164)=.94, p=.45) for role physical. Over time, veterans improved in their physical function (F(2,170)=5.34, p<.01; ὴ2 partial=.06), PTSD symptoms (F(2,170)=9.39, p<.01; ὴ2 partial=.10), depressive symptoms (F(2,170)=10.81, p<.01, ὴ2 partial=.11), and physical symptoms (F(2, 172)=12.65, p<.01; ὴ2 partial=.13), but these improvements did not differ across study arms over time. Completer analyses yielded similar results. There were no differences in catastrophizing between arms. CONCLUSION Findings suggest stress reduction may not be the right target for improving disability among veterans with CMI. Veterans with CMI may need intervention that directly impacts medical self-management to improve disability.
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Affiliation(s)
- Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A.,Department of Educational and Counseling Psychology, University at Albany, Albany, NY, U. S. A
| | - Lauren M. Greenberg
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
| | - Donald S. Ciccone
- Department of Psychiatry, New Jersey Medical School, Rutgers University, Newark, NJ, U. S. A
| | - Drew A. Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A.,Department of Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, U. S. A
| | - Helena K. Chandler
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
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Van Houtven CH, Miller KEM, O'Brien EC, Wolff JL, Lindquist J, Kabat M, Campbell-Kotler M, Henius J, Voils CI. Development and Initial Validation of the Caregiver Perceptions About Communication With Clinical Team Members (CAPACITY) Measure. Med Care Res Rev 2017; 76:784-806. [PMID: 29262757 DOI: 10.1177/1077558717747985] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the important role that family caregivers play managing the care of persons with complex health needs, little is known about how caregivers perceive themselves to be recognized and valued by health care professionals. Our objective was to develop and validate a novel measure, the CAregiver Perceptions About CommunIcation with Clinical Team members (CAPACITY) instrument. Questions focus on perceived quality of communication with the health care team and the extent to which caregivers believe that the health care team considers their capacity and preferences in decision making. A confirmatory factor analysis supported a two-factor solution addressing communication and capacity. Internal consistency reliability was .90 for the communication domain and .93 for the capacity domain. Correlations between these two subscales and individual difference measures provided evidence of convergent and discriminant validity. The CAPACITY instrument may be a useful performance measure that quantifies the extent to which caregivers' experience person- and family-centered health care.
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Affiliation(s)
| | | | | | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Corrine I Voils
- William S, Middleton Veterans Memorial Hospital, Madison, WI, USA.,University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
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Soble JR, Santos OA, Bain KM, Kirton JW, Bailey KC, Critchfield EA, O’Rourke JJF, Highsmith JM, González DA. The Dot Counting Test adds up: Validation and response pattern analysis in a mixed clinical veteran sample. J Clin Exp Neuropsychol 2017; 40:317-325. [DOI: 10.1080/13803395.2017.1342773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jason R. Soble
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Octavio A. Santos
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Kathleen M. Bain
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Joshua W. Kirton
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - K. Chase Bailey
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Edan A. Critchfield
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | | | - David Andrés González
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Golden SE, Miller D, Hansen L, Peters D, Taylor-Young P. The experience of veterans with hepatitis C and acupuncture: A mixed methods pilot study. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Total knee arthroplasty is a large contributor to Medicare costs. In an effort to lower costs and improve outcomes, the Centers for Medicaid and Medicare Services has implemented the Comprehensive Care for Joint Replacement model, which incentivizes surgeons to submit both general health and joint-specific patient-reported outcome measures (PROMs). However, in addition to using PROMs for reporting purposes, surgeons should also consider incorporating PROMs into clinical practice. Currently, PROMs are not widely implemented in the clinical setting despite their value in measuring factors such as patients' expectations and mental state, which impact outcomes. Furthermore, as technology improves, PROM collection will become faster and more efficient. The information collected by PROMs can inform treatment decisions and facilitate communication between the surgeon and the patient.
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