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Jackson GL, Fix GM, White BS, Cutrona SL, Reardon CM, Damschroder LJ, Burns M, DeLaughter K, Opra Widerquist MA, Arasim M, Lindquist J, Gifford AL, King HA, Kaitz J, Jasuja GK, Hogan TP, Lopez JCF, Henderson B, Fitzgerald BA, Goetschius A, Hagan D, McCoy C, Seelig A, Nevedal A. Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration. Front Health Serv 2024; 3:1223277. [PMID: 38420338 PMCID: PMC10900518 DOI: 10.3389/frhs.2023.1223277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024]
Abstract
Introduction The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA. Methods Organized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators. Results In the first eight Shark Tanks (2016-2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank. Conclusion DoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J. Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Madison Burns
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | | | - Maria Arasim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Heather A. King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Division of General Internal Medicine, Duke University, Durham, NC, United States
| | - Jenesse Kaitz
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Guneet K. Jasuja
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Timothy P. Hogan
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Jaifred Christian F. Lopez
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Blake Henderson
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Blaine A. Fitzgerald
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Amber Goetschius
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Danielle Hagan
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Carl McCoy
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Alex Seelig
- Agile Six Applications, Inc., San Diego, CA, United States
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
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Perfect CR, Lindquist J, Smith VA, Stanwyck C, Seidenfeld J, Van Houtven CH, Hastings SN. Are Geriatrics-Focused Primary Care Clinics Better at Diagnosing Dementia Than Traditional Clinics? A Matched Cohort Study. J Gen Intern Med 2023; 38:2710-2717. [PMID: 36941424 PMCID: PMC10506971 DOI: 10.1007/s11606-023-08136-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Dementia and mild cognitive impairment (MCI) are prevalent but underdiagnosed. OBJECTIVE To compare new dementia/MCI diagnosis rates in geriatrics-focused primary care clinics and traditional primary care clinics. DESIGN Secondary analysis of a prospective matched cohort study that spanned 2017-2021. PARTICIPANTS Community-dwelling Veterans over 65 receiving primary care in a geriatrics-focused medical home (GeriPACT) or traditional primary care home (PACT) at one of 57 Veterans Affairs sites. We excluded individuals with a documented diagnosis of dementia or MCI in the year prior to enrollment. MAIN MEASURES Diagnoses obtained from EHR. Cognitive status was assessed using modified Telephone Interview for Cognitive Status (mTICS) tool. KEY RESULTS The 470 participants included in this analysis were predominantly white, non-Hispanic males with an average age of 80.3 years. 9.4% of participants received a diagnosis of dementia/MCI after 24 months: 11.5% in GeriPACT and 7.2% in PACT. Adjusted OR for dementia/MCI diagnosis based on GeriPACT exposure was 1.47 (95% CI 0.65-3.29). Low mTICS score (≤ 27) (OR 4.89, 95% CI 2.36-10.13) and marital status (married/partnered) (OR 1.89, CI 0.99-3.59) were independent predictors of dementia/MCI diagnosis. When stratified by cognitive status: diagnosis rates were 20.8% in GeriPACT and 16.7% in PACT among those who scored lower on the cognitive assessment (mTICS ≤ 27); 7.4% in GeriPACT and 3.6% in PACT among those who scored higher (mTICS > 27). The OR for new dementia/MCI diagnosis in GeriPACT was 1.19 (95% CI 0.49-2.91) among those with a low mTICS score and 1.85 (95% CI 0.70-4.88) among those with a higher mTICS score. CONCLUSIONS Observed rates of new dementia/MCI diagnosis were higher in GeriPACT, but with considerable uncertainty around estimates. Geriatrics-focused primary care clinics may be a promising avenue for improving the detection of dementia in older adults, but further larger studies are needed to confirm this relationship.
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Affiliation(s)
- Chelsea R Perfect
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - J Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - V A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of General Internal Medicine, Duke University, Durham, NC, USA
| | - C Stanwyck
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
| | - J Seidenfeld
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Emergency Medicine, Durham VA Health Care System, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - C H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - S N Hastings
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA
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Malavia M, Lindquist J, Marchak K, Trivedi P, Casadaban L. Abstract No. 268 Modified Radiation Lobectomy as Bridge to Liver Resection: A Single-Center Experience. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Bent Robinson E, Casadaban L, Neves Da Silva H, Annam A, Lindquist J, Rochon P. Abstract No. 510 Retrospective Analysis of Recanalization Rates Using Non-Fibered Coils for Pulmonary Arteriovenous Malformation Occlusion. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Vashi AA, Orvek EA, Tuepker A, Jackson GL, Amrhein A, Cole B, Asch SM, Gifford AL, Lindquist J, Marshall NJ, Newell S, Smigelsky MA, White BS, White LK, Cutrona SL. The Veterans Health Administration (VHA) Innovators Network: Evaluation design, methods and lessons learned through an embedded research approach. Healthc (Amst) 2021; 8 Suppl 1:100477. [PMID: 34175094 DOI: 10.1016/j.hjdsi.2020.100477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/14/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Collaboration between researchers, implementers and policymakers improves uptake of health systems research. In 2018, researchers and VHA Innovators Network (iNET) leadership used an embedded research model to conduct an evaluation of iNET. We describe our evaluation design, early results, and lessons learned. METHODS This mixed-methods evaluation incorporated primary data collection via electronic survey, descriptive analysis using existing VA datasets (examining associations between facility characteristics and iNET participation), and qualitative interviews to support real-time program implementation and to probe perceived impacts, benefits and challenges of participation. RESULTS We developed reporting tools and collected data regarding site participation, providing iNET leadership rapid access to needed information on projects (e.g., target populations reached, milestones achieved, and barriers encountered). Secondary data analyses indicated iNET membership was greater among larger, more complex VA facilities. Of the 37 iNET member sites, over half (n = 22) did not have any of the six major types of VA research centers; thus iNET is supporting VA sites not traditionally served by research innovation pathways. Qualitative findings highlighted enhanced engagement and perceived value of social and informational networks. CONCLUSIONS Working alongside our iNET partners, we supported and influenced iNET's development through our embedded evaluation's preliminary findings. We also provided training and guidance aimed at building capacity among iNET participants. IMPLICATIONS Embedded research can yield successful collaborative efforts between researchers and partners. An embedded research team can help programs pivot to ensure effective use of limited resources. Such models inform program development and expansion, supporting strategic planning and demonstrating value.
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Affiliation(s)
- Anita A Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Emergency Medicine (Affiliated), Stanford University, Stanford, CA, USA.
| | - Elizabeth A Orvek
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Quantitative Methods Core, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; Department of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Amrhein
- Department of Veterans Affairs, Veterans Health Administration Innovators Network, USA
| | - Brynn Cole
- Department of Veterans Affairs, Veterans Health Administration Innovators Network, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Nell J Marshall
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Summer Newell
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Melissa A Smigelsky
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Veterans Integrated Service Network (VISN) 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Health Care System, Durham, NC, USA
| | - Brandolyn S White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Lindsay K White
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Shepherd-Banigan M, Sherman S, Lindquist J, Miller K, Tucker M, Smith V, Van Houtven C. Family Caregivers of Veterans Experience High Burden, Mental Health Distress, and Financial Strain. Innov Aging 2020. [PMCID: PMC7743457 DOI: 10.1093/geroni/igaa057.2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We describe the caregiving experiences and needs of family caregivers of older Veterans enrolled in the U.S. Department of Veterans Affairs (VA). We conducted telephone surveys with 1,509 caregivers to assess caregiver health and well-being. Caregivers were primarily female, <50 years old, white, and the Veterans’ spouse. Veterans had substantial functional limitations and required care for multiple conditions, commonly, mental illness, dementia, and heart disease. On average, caregivers provided care for 9.6 hours per day and 6.7 days per week. Burden and depressive symptoms were above clinical thresholds with average scores of 21.8 (Zarit burden) and 11.5 (CES-D 10). Levels of perceived loneliness and financial strain were high. As this population needs emotional support, respite care services, social engagement, and training to care for aging Veterans, the expansion of enhanced caregiver services and supports to this population (expected in 2020) through the VA Mission Act of 2018 will be beneficial.
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Affiliation(s)
| | - Sophia Sherman
- US Department of Veterans Affairs HSR&D, Durham, North Carolina, United States
| | - Jennifer Lindquist
- US Department of Veterans Affairs HSR&D, Durham, North Carolina, United States
| | - Katherine Miller
- US Department of Veterans Affairs HSR&D, Durham, North Carolina, United States
| | - Matthew Tucker
- US Department of Veterans Affairs HSR&D, Durham, North Carolina, United States
| | - Valerie Smith
- U.S. Department of Veterans Affairs HSR&D, Durham, North Carolina, United States
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Jackson GL, Cutrona SL, White BS, Reardon CM, Orvek E, Nevedal AL, Lindquist J, Gifford AL, White L, King HA, DeLaughter K, Houston TK, Henderson B, Vega R, Kilbourne AM, Damschroder LJ. Merging Implementation Practice and Science to Scale Up Promising Practices: The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) Program. Jt Comm J Qual Patient Saf 2020; 47:217-227. [PMID: 33549485 DOI: 10.1016/j.jcjq.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program developed and manages a framework for identification, replication, and diffusion of promising practices throughout the nation's largest integrated health care system. DoE identifies promising practices through a "Shark Tank" competition with winning bidders receiving external implementation facilitation. DoE further supports diffusion of successful practices across the VHA. METHODS This article presents results of a mixed methods implementation evaluation of DoE, focusing on program reach, program participation and decisions to adopt innovative practices, implementation processes, and practice sustainment. Data sources include practice adoption metrics, focus groups with bidders (two focus groups), observations of DoE events (seven events), surveys of stakeholders (five separate surveys), and semistructured interviews of facility directors, practice developers, implementation teams, and facilitators (133 participants). RESULTS In the first four Shark Tank cohorts (2016-2018), 1,676 practices were submitted; 47 were designated Gold Status Practices (practices with facilitated implementation). Motivation for participation varied. Generally, staff led projects targeting problems they felt passionate about, facility directors focused on big-picture quality metrics and getting middle manager support, and frontline staff displayed variable motivation to implement new projects. Approximately half of facilitated implementation efforts were successful; barriers included insufficient infrastructure, staff, and resources. At the facility level, 73.3% of facilities originating or receiving facilitated implementation support have maintained the practice. VHA-wide, 834 decisions to adopt these practices were made. CONCLUSION DoE has resulted in the identification of many candidate practices, promoted adoption of promising practices by facility directors, and supported practice implementation and diffusion across the VHA.
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Jackson G, Cutrona S, White B, Reardon C, Orvek E, Nevedal A, Lindquist J, Gifford A, King H, DeLaughter K, Henderson B, Vega R, Damschroder L. Identifying, Replicating, and Spreading Health care Innovations across a Nation‐Wide Health care System: VHA Diffusion of Excellence. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- G. Jackson
- Durham Veterans Affairs Health Care System Durham NC United States
- Duke University Durham NC United States
| | - S. Cutrona
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System Durham NC United States
| | - C. Reardon
- VA Ann Arbor Healthcare System Ann Arbor MI United States
| | - E. Orvek
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - A. Nevedal
- VA Palo Alto Health Care System Menlo Park CA United States
| | - J. Lindquist
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - A. Gifford
- VA Boston Healthcare System Boston MA United States
- Boston University Boston MA United States
| | - H. King
- Duke University Durham NC United States
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - K. DeLaughter
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. Henderson
- United States Veterans Health Administration Innovation Ecosystem Washington DC United States
| | - R. Vega
- Veterans Health Administration (VHA) Innovation Ecosystem Washington DC United States
| | - L. Damschroder
- VA Ann Arbor Healthcare System Ann Arbor MI United States
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Wadhwa V, DeWitt P, Lindquist J, Trivedi P. Abstract No. 665 Association of inferior vena cava filter placement and mortality among in-patients with pulmonary embolism after adjusting for immortal time bias. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Lindquist J, Jensen A, Brown M, Rochon P, Ryu R, Trivedi P. 3:45 PM Abstract No. 57 Racial disparity in access to endoscopy and transjugular intrahepatic portosystemic shunt creation for acute variceal bleeding in the United States. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Smith VA, Lindquist J, Miller KEM, Shepherd-Banigan M, Olsen M, Campbell-Kotler M, Henius J, Kabat M, Van Houtven CH. Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group. Front Public Health 2019; 7:122. [PMID: 31179259 PMCID: PMC6538764 DOI: 10.3389/fpubh.2019.00122] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: In May 2010, the Caregivers and Veterans Omnibus Health Services Act of 2010, was signed into law in the United States, establishing the Program of Comprehensive Assistance for Family Caregivers (PCAFC) provided through the VA Caregiver Support Program (CSP). Prior to this program, over half of family caregivers reported being untrained for the tasks they needed to provide. The training through PCAFC represents the largest effort to train family caregivers in the U.S., and the features of the program, specifically a monthly stipend to caregivers and access to a Caregiver Support Coordinator at each VA medical center nationally, make it the most comprehensive caregiver support program ever enacted in the U.S. Methods: The purpose of this study is to examine the association between PCAFC participation and caregiver well-being following enrollment, comparing participating PCAFC caregivers to caregivers who applied to but were not approved for PCAFC participation (non-participants). Well-being is defined using three diverse but related outcomes: depressive symptoms, perceived financial strain, and perceived quality of the Veteran's health care. Additional well-being measures also examined include the Zarit Burden Inventory and positive aspects of caregiving. Results: The survey sample comprised of 92 caregivers approved for PCAFC and 66 caregivers not approved. The mean age of responding caregivers was 45; over 90% of caregivers were female; and over 80% of caregivers were married in both groups. We find promising trends in well-being associated with PCAFC participation. First, the perception of financial strain declined among participants compared to non-participants. Second, while depressive symptoms did not improve for the PCAFC caregivers, depressive symptoms increased among non-participants. Third, perceived quality of the Veteran's VA healthcare was no different between participants and non-participants. However, the 158 returned surveys reflect only a 5% response rate; hence this evidence is preliminary. Conclusion: Despite cautioning that results be interpreted as preliminary, this study provides unique descriptive information about young caregivers of U.S. post-9/11 Veterans, and offers a first step in filling the evidence gap about how comprehensive caregiver support in the U.S. may affect caregiver well-being. These preliminary findings should be explored and validated in a larger sample.
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Affiliation(s)
- Valerie A Smith
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Jennifer Lindquist
- Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States
| | - Katherine E M Miller
- Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States.,Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States
| | - Maren Olsen
- Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Margaret Campbell-Kotler
- Caregiver Support Program, United States Department of Veterans Affairs, Seattle, WA, United States
| | - Jennifer Henius
- Caregiver Support Program, United States Department of Veterans Affairs, Seattle, WA, United States
| | - Margaret Kabat
- Caregiver Support Program, United States Department of Veterans Affairs, Seattle, WA, United States
| | - Courtney Harold Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States
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Lindquist J, Reghunathan A, Brown M, Schramm K, Trivedi P, Ryu R, Lindquist J. 04:21 PM Abstract No. 198 Comparison of the Captus device versus conventional snare for IVC filter retrieval. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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Bruening R, Sperber N, Miller K, Andrews S, Steinhauser K, Wieland GD, Lindquist J, Shepherd-Banigan M, Ramos K, Henius J, Kabat M, Van Houtven C. Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program. J Appl Gerontol 2019; 39:368-376. [PMID: 30658547 DOI: 10.1177/0733464818825050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Development and evaluation of supportive caregiver interventions has become a national priority. This study's aim was to evaluate how caregivers participating in the Department of Veterans Affairs (VA) Caregiver Support Program (CSP) use and value supportive services. Qualitative semi-structured interviews (N = 50 caregivers) were the core of a mixed-methods design, and surveys (N = 160) were supplemental. Caregivers who had used CSP services valued emotional, functional, and health care navigational support, calling support groups and the program coordinator their "lifeline." However, many described a lack of connection with the program-not knowing about or successfully engaging in program services-and needed more information about available resources. Caregivers in rural areas or caring for individuals with specific diseases reported needing tailored services to meet their unique needs. Policy makers and practitioners should proactively promote supportive services for caregivers. Future research should explore strategies for reducing barriers to accessing tailored support to meet the needs of a diverse caregiver population.
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Affiliation(s)
| | - Nina Sperber
- Durham VA Medical Center, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | | | - Sara Andrews
- RTI International, Research Triangle Park, NC, USA
| | - Karen Steinhauser
- Durham VA Medical Center, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - G Darryl Wieland
- Durham VA Medical Center, NC, USA.,Duke University, Durham, NC, USA
| | | | | | - Katherine Ramos
- Durham VA Medical Center, NC, USA.,Duke University, Durham, NC, USA
| | - Jennifer Henius
- United States Department of Veterans Affairs Caregiver Support Program Office, Washington, DC, USA
| | - Margaret Kabat
- United States Department of Veterans Affairs Caregiver Support Program Office, Washington, DC, USA
| | - Courtney Van Houtven
- Durham VA Medical Center, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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14
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Zullig LL, Smith V, Lindquist J, Williams CD, Weinberger M, Provenzale D, Jackson GL, Kelley MJ, Danus S, Bosworth HB. Cardiovascular disease-related chronic conditions among Veterans Affairs colorectal cancer survivors: A matched case-control analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4 Background: The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing CRC survivors and matched non-cancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with CVD-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Methods: We retrospectively identified patients diagnosed with non-metastatic CRC in the Veterans Affairs (VA) healthcare system from fiscal years 2009-2012 and matched each with up to 3 non-cancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between CRC survivors and non-cancer controls. Results: We identified 9,758 CRC patients and matched them to 29,066 non-cancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched non-cancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR = 1.57, 95% CI = 1.49-1.64) and 12% higher odds of poor blood pressure control (OR = 1.12, 95% CI 1.06-1.18) in the subsequent year. Compared to matched non-cancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR = 0.50, 95% CI = 0.48-0.52) and higher odds of LDL control (OR 1.14, 95% CI 1.06-1.23). There were no significant differences between groups for diabetes diagnoses or control. Conclusions: Compared to non-cancer controls, CRC survivors have: 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
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Affiliation(s)
| | | | | | | | | | | | - George L. Jackson
- Health Services Research and Development, Durham VA Medical Center, Durham, NC
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Van Houtven C, Lindquist J, Smith V, Chapman J, Hendrix C, Hastings S, Oddone E, Weinberger M. EFFECT OF FAMILY CAREGIVER SKILLS TRAINING ON PERCEIVED QUALITY OF CARE AND DEPRESSIVE SYMPTOMS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Van Houtven
- Durham VA and Duke University Medical Centers, Durham, North Carolina,
| | - J. Lindquist
- Durham VA Medical Center, Durham, North Carolina,
| | - V.A. Smith
- Durham VA and Duke University Medical Centers, Durham, North Carolina,
| | - J. Chapman
- Durham VA Medical Center, Durham, North Carolina,
| | - C.C. Hendrix
- Durham VA and Duke University Medical Centers, Durham, North Carolina,
| | - S.N. Hastings
- Durham VA and Duke University Medical Centers, Durham, North Carolina,
| | - E.Z. Oddone
- Durham VA and Duke University Medical Centers, Durham, North Carolina,
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17
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Zullig LL, Smith VA, Jackson GL, Danus S, Schnell M, Lindquist J, Provenzale D, Weinberger M, Kelley MJ, Bosworth HB. Colorectal Cancer Statistics From the Veterans Affairs Central Cancer Registry. Clin Colorectal Cancer 2016; 15:e199-e204. [PMID: 27301717 PMCID: PMC5099105 DOI: 10.1016/j.clcc.2016.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is a common and potentially deadly disease. Although the United States has robust cancer data reporting, information from the Department of Veterans Affairs (VA) healthcare system has often been underrepresented in national cancer data sources. We describe veterans with incident CRC in terms of their patient and tumor characteristics and mortality. PATIENTS AND METHODS Patients diagnosed or treated with CRC at any VA institution in the fiscal years 2009 to 2012 were identified using 3 data sources: (1) VA Central Cancer Registry (VACCR); (2) VA Corporate Data Warehouse; and (3) VA Reports and Measures Portal. The CRC frequencies within the VA population and survival curves were examined descriptively and compared with the national projections using Surveillance, Epidemiology, and End Results program data. RESULTS A total of 12,551 veterans with CRC were included in the present analysis. The median age at diagnosis was 65.5 years. Approximately 97% (n = 12,229) of the CRC cases were diagnosed among men. Approximately 44% (n = 5517) of the patients were diagnosed with localized disease. The 3-year survival rate was associated with age (P < .01) and stage (P < .01) at diagnosis. We identified a possible decrease in VA CRC incidence over time. CONCLUSION Although the VA CRC patient population was heavily skewed toward the male gender, the patient and tumor characteristics were similar between the incident CRC cases reported by the VACCR and those reported to the Surveillance, Epidemiology, and End Results program. This suggests that research findings resulting from the VACCR might have applicability beyond the VA healthcare system setting.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC.
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Merritt Schnell
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Jennifer Lindquist
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Cooperative Studies Program Epidemiology Center, Durham, NC; Division of Gastroenterology, Duke University Medical Center, Durham, NC
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Michael J Kelley
- Office of Patient Care Services, Department of Veterans Affairs, Washington, DC; Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC; Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC; Department of Psychiatry and Behavioral Sciences, School of Nursing, Duke University, Durham, NC
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18
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Rohr I, Sehouli J, En-Nia A, Heinrich M, Richter R, Chekerov R, Dechend R, Heidecke H, Dragun D, Schäfer R, Gorny X, Lindquist J, Brandt S, Braicu E, Mertens P. Y-box protein-1/p18 as novel serum marker for ovarian cancer diagnosis: A study by the Tumor Bank Ovarian Cancer (TOC). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Zullig LL, Smith V, Danus S, Schnell M, Lindquist J, Provenzale DT, Jackson GL, Weinberger M, Kelley MJ, Bosworth HB. Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.e267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e267 Background: Our objective was to evaluate VA CRC incidence and survival and compare with the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. Methods: Data were obtained from VACCR for veterans diagnosed/treated in VA for incident CRC during fiscal years (FY) 2009-2012. Using VHA Support Service Center information about the distribution of VA healthcare system enrollees for corresponding years, we adjusted incidence rates for age and gender to the underlying VA population. Survival data were available through January 2015; thus, patients in the analysis had 3-6 years of follow-up data and were censored accordingly. CRC incidence and survival among VA patients was compared to projected national 2014 CRC-specific SEER and supporting data sources. Results: From FY 2009-2012, 12,551 patients (2.6% women; 97.4% men) were in the analytic cohort. Among VACCR patients, the most common tumor location was proximal colon (38%), followed by rectum (31%), distal colon (26%), and other colon (5%). This is comparable to SEER, in which proximal colon and rectum are most common. Among patients in the VACCR, SEER summary stage distribution was: 44% local, 36% regional, 17% distant and 4% unknown. This also aligns with SEER, in which approximately 40% of CRC cases are diagnosed locally. Mirroring SEER, overall VA CRC incidence rate decreased from 0.22 to 0.16 cases per 1,000 veterans in FYs 2009 and 2012. Evaluating survival, median follow-up time was 3.3 years among veterans. The 3-year survival rate for VA patients was 65.9%. Overall 3-year survival is slightly higher for rectal (66.4%) than for colon (65.6%). This is comparable to 5-year SEER survival rates (66.5% and 64.2% for rectal and colon, respectively). Also consistent with SEER, VA CRC patients < 65 have higher rates of 3-year survival than patients > 65 years (74.6% vs. 58.5%, respectively). Conclusions: VACCR data indicate that CRC incidence and survival in FY 2009-2012 approximated SEER projections during a similar timeframe. This suggests that, although VA patients are more complex than the general population, they are diagnosed with comparable CRC locations and stages.
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Affiliation(s)
- Leah L. Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | | | | | | | | | - Dawn T. Provenzale
- Health Services Research and Development, Durham VA Medical Center, Durham, NC
| | - George L. Jackson
- Health Services Research and Development, Durham VA Medical Center, Durham, NC
| | - Morris Weinberger
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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20
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Van Houtven CH, Oddone EZ, Hastings SN, Hendrix C, Olsen M, Neelon B, Lindquist J, Weidenbacher H, Boles J, Chapman J, Weinberger M. Helping Invested Families Improve Veterans' Experiences Study (HI-FIVES): study design and methodology. Contemp Clin Trials 2014; 38:260-9. [PMID: 24837544 DOI: 10.1016/j.cct.2014.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 05/02/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
Within the Veterans Health Administration (VHA), the largest integrated health care system in the US, approximately 8.5 million Veteran patients receive informal care. Despite a need for training, half of VHA caregivers report that they have not received training that they deemed necessary. Rigorous study is needed to identify effective ways of providing caregivers with the skills they need. This paper describes the Helping Invested Families Improve Veterans' Experience Study (HI-FIVES), an ongoing randomized controlled trial that is evaluating a skills training program designed to support caregivers of cognitively and/or functionally impaired, community-dwelling Veterans who have been referred to receive additional formal home care services. This two-arm randomized controlled trial will enroll a total of 240 caregiver-patient dyads. For caregivers in the HI-FIVES group, weekly individual phone training occurs for 3 weeks, followed by 4 weekly group training sessions, and two additional individual phone training calls. Caregivers in usual care receive information about the VA Caregiver Support Services Program services, including a hotline number. The primary outcome is the number of days a Veteran patient spends at home in the 12 months following randomization (e.g. not in the emergency department, inpatient or nursing home setting). Secondary outcomes include patient VHA health care costs, patient and caregiver satisfaction with VHA health care, and caregiver depressive symptoms. Outcomes from HI-FIVES have the potential to improve our knowledge of how to maximize the ability to maintain patients safely at home for caregivers while preventing poor mental health outcomes among caregivers.
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Affiliation(s)
- Courtney Harold Van Houtven
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 W. Chapel Hill Street, NC Mutual Building, Ste 500, Durham, NC 27710, USA.
| | - Eugene Z Oddone
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 W. Chapel Hill Street, NC Mutual Building, Ste 500, Durham, NC 27710, USA.
| | - Susan N Hastings
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Division of Geriatrics, Department of Medicine, Duke University Medical Center, DUMC Box 3003, Durham, NC 27710, USA; Geriatric Research, Education, and Clinical Center, Durham VAMC 508 Fulton Street Durham NC 27705, USA; Center for the Study of Aging and Human Development Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South, Durham, NC 27710, USA.
| | - Cristina Hendrix
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; School of Nursing, Duke University Medical Center, 307 Trent Drive, Box 102400, Durham, NC 27710, USA; Center for the Study of Aging and Human Development Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South, Durham, NC 27710, USA.
| | - Maren Olsen
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Department of Biostatistics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC 27710, USA.
| | - Brian Neelon
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Department of Biostatistics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC 27710, USA.
| | - Jennifer Lindquist
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
| | - Hollis Weidenbacher
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
| | - Jillian Boles
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 W. Chapel Hill Street, NC Mutual Building, Ste 500, Durham, NC 27710, USA.
| | - Jennifer Chapman
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, U.S. Department of Veterans Affairs, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Department of Health Policy and Management, 1105B McGavran-Greenberg Hall, Campus Box 7411, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Zullig LL, Shaw RJ, Crowley MJ, Lindquist J, Grambow SC, Peterson E, Shah BR, Bosworth HB. Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circ Cardiovasc Qual Outcomes 2013; 6:619-25. [PMID: 24221839 DOI: 10.1161/circoutcomes.113.000435] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence. METHODS AND RESULTS Using baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96-2.76), female sex (β=1.22; 95% CI [0.22-2.24]), minority race (β=1.72; 95% CI [0.78-2.66]), having less than high school education (β=2.05; 95% CI [0.71-3.39]), low health literacy (β=2.06; 95% CI [0.86-3.26]), and inadequate financial status (β=1.93; 95% CI [0.87-3.00]). Being married (β=-2.09, 95% CI [-3.03 to -1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02-1.12]) in odds of reporting medication nonadherence. CONCLUSIONS Our results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
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22
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Steinhauser KE, Arnold RM, Olsen MK, Lindquist J, Hays J, Wood LL, Burton AM, Tulsky JA. Comparing three life-limiting diseases: does diagnosis matter or is sick, sick? J Pain Symptom Manage 2011; 42:331-41. [PMID: 21276704 PMCID: PMC3597229 DOI: 10.1016/j.jpainsymman.2010.11.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/12/2010] [Accepted: 11/23/2010] [Indexed: 12/20/2022]
Abstract
CONTEXT At advanced stages, cancer, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) produce high rates of hospitalization, disability, and annual mortality. Despite similar prognoses, patients with cancer often are treated differently than those with other illnesses, the former being seen as terminal vs. chronic. OBJECTIVES The purpose of this study was to compare the functional capacity, emotional well-being, and quality of life of patients in three disease groups to assess whether diagnosis distinguishes differences in patient experience, and compare patients with cancer and noncancer diagnoses. METHODS Baseline data from a cohort study of 210 patients who had an estimated 50% two-year mortality were analyzed. The patients had Stage IV breast, prostate, or colon cancer; Stage IIIb or IV lung cancer; New York Heart Association Stage III or IV CHF with a left ventricular ejection fraction of <40%; or COPD with hypercapnea (pC02>46) and at least one hospitalization or Emergency Department visit during the past year. Measures included the Rosow-Breslau Activities of Daily Living/Instrumental Activities of Daily Living tool, Profile of Mood States anxiety subscale, brief Centers for Epidemiologic Studies Depression Scale, and the Functional Assessment of Cancer Therapy-General quality-of-life instrument. Analyses included descriptive statistics, analysis of variance, and adjusted linear regression models. RESULTS A majority of illness outcomes did not differ by diagnostic category. Functional status was associated with diagnosis, with CHF and COPD patients faring worse than those with cancer. Overall, illness experience was most significantly related to disease severity, demographics, and emotional and social well-being. CONCLUSION Comparing patients with advanced cancer, CHF, and COPD, illness experience was more similar than different. Patients living with life-limiting illnesses other than cancer may benefit from whole-person services often extended to cancer patients.
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Affiliation(s)
- Karen E Steinhauser
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina 27705, USA.
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23
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Shah BR, Adams M, Peterson ED, Powers B, Oddone EZ, Royal K, McCant F, Grambow SC, Lindquist J, Bosworth HB. Secondary prevention risk interventions via telemedicine and tailored patient education (SPRITE): a randomized trial to improve postmyocardial infarction management. Circ Cardiovasc Qual Outcomes 2011; 4:235-42. [PMID: 21406672 DOI: 10.1161/circoutcomes.110.951160] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondary prevention by risk factor modification improves patient outcomes, yet it is often not achieved in clinical practice. Reasons for failure stem from challenges of prioritizing risk factor reduction and engaging patients in changing their behaviors. We hypothesize that a novel telemedicine intervention with tailored patient education could improve cardiovascular risk factors. METHODS To evaluate this intervention, we propose enrolling 450 patients with a recent myocardial infarction and hypertension into a 3-arm randomized, controlled trial. The first arm (n=150) will receive home blood pressure (BP) monitors plus a nurse-delivered, telephone-based tailored patient education intervention and will be enrolled into HealthVault, a Microsoft electronic health record platform. The second arm (n=150) will also receive BP monitors plus a tailored patient education intervention and be enrolled in HeartVault. However, the patient education intervention will be delivered by a Web-based program and will cover topics identical to those in the nurse-delivered intervention. Both arms will be compared with a control group receiving standard care (n=150). All participants will have an in-person assessment at baseline and at completion of the study, including standardized measurements of BP, LDL cholesterol, and glycosylated hemoglobin (in diabetic subjects). The study design will allow assessment of a telephone-based, nurse-administered disease management program versus standard care. The main outcome of interest is the reduction in systolic BP in each intervention group compared with the control group at 12 months. Secondary outcomes assessed will include reductions in LDL cholesterol, body weight, and glycosylated hemoglobin, as well as adherence to evidence-based therapies and improvement in health behaviors. CONCLUSION If successful in optimizing BP control, managing other coronary heart disease risk factors, and demonstrating a lower cost, the Web-based disease management tool has the potential to enhance coronary artery disease management, quality of care, and ultimately, patient outcomes. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901277.
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Affiliation(s)
- Bimal R Shah
- Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA.
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24
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Wai ES, Lesperance ML, Alexander CS, Truong PT, Moccia P, Culp M, Lindquist J, Olivotto IA. Predictors of Local Recurrence in a Population-Based Cohort of Women with Ductal Carcinoma In Situ Treated with Breast Conserving Surgery Alone. Ann Surg Oncol 2010; 18:119-24. [DOI: 10.1245/s10434-010-1214-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Indexed: 11/18/2022]
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Interrante V, Ries B, O'Rourke E, Gray L, Lindquist J, Anderson L. Evaluating alternative metaphors for augmented locomotion through large scale immersive virtual environments. J Vis 2010. [DOI: 10.1167/7.9.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Exner H, Gibson EK, Stone R, Lindquist J, Cowen L, Roth EA. Worry as a window into the lives of people who use injection drugs: a factor analysis approach. Harm Reduct J 2009; 6:20. [PMID: 19640277 PMCID: PMC2724504 DOI: 10.1186/1477-7517-6-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 07/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of risk dominates the HIV/AIDS literature pertaining to People Who Use Injection Drugs (PWUID). In contrast the associated concept of worry is infrequently applied, even though it can produce important perspectives of PWUID's lives. This study asked a sample (n = 105) of PWUID enrolled in a Victoria, British Columbia needle exchange program to evaluate their degree of worry about fourteen factors they may encounter in their daily lives. METHODS Exploratory factor analysis was used to analyze their responses. RESULTS Factor analysis delineated three factors: 1) overall personal security, 2) injection drug use-specific risks including overdosing and vein collapse and, 3) contracting infectious diseases associated with injection drug use (e.g. HIV/AIDS and hepatitis C). CONCLUSION PWUID in this study not only worry about HIV/AIDS but also about stressful factors in their daily life which have been linked to both increased HIV/AIDS risk behaviour and decreased anti-retroviral treatment adherence. The importance PWUID give to this broad range of worry/concerns emphasizes the need to place HIV/AIDS intervention, education, and treatment programs within a broader harm-reduction framework that incorporates their perspectives on both worry and risk.
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Affiliation(s)
- Heidi Exner
- AIDS Vancouver Island, 1601 Blanshard Avenue, Victoria, British Columbia, V8W 2J5, Canada
| | - Erin K Gibson
- AIDS Vancouver Island, 1601 Blanshard Avenue, Victoria, British Columbia, V8W 2J5, Canada
| | - Ryan Stone
- Department of Mathematics and Statistics, PO BOX 3060 STN CSC, Victoria, British Columbia, V8W 3R4, Canada
| | - Jennifer Lindquist
- Department of Mathematics and Statistics, PO BOX 3060 STN CSC, Victoria, British Columbia, V8W 3R4, Canada
| | - Laura Cowen
- Department of Mathematics and Statistics, PO BOX 3060 STN CSC, Victoria, British Columbia, V8W 3R4, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, PO Box 3050, STN CSC, Victoria, British Columbia, V8W 3P5, Canada
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Pastula D, Coffman C, Allen K, Oddone E, Kasarskis E, Lindquist J, Morgenlander J, Norman B, Rozear M, Sams L, Sabet A, Bedlack R. Factors associated with survival in the National Registry of Veterans with ALS. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17482960802320545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coffman CJ, Horner RD, Grambow SC, Lindquist J. Estimating the Occurrence of Amyotrophic Lateral Sclerosis among Gulf War (1990–1991) Veterans Using Capture-Recapture Methods. Neuroepidemiology 2005; 24:141-50. [PMID: 15650320 DOI: 10.1159/000083297] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Using data from a recent report that indicated a 2-fold higher risk of amyotrophic lateral sclerosis (ALS) among veterans of the 1991 Gulf War, we applied capture-recapture methodology to estimate possible under-ascertainment of ALS cases among deployed and non-deployed military personnel who were on active duty during that war. STUDY DESIGN AND SETTING One of the most serious concerns facing field epidemiological investigations is that of case ascertainment bias, particularly when it is differential among the study groups. Capture-recapture methods, however, have promise as an approach to assessing the impact of case ascertainment bias in such studies. To overcome potential limitations of any one approach, three different estimation methods were used: log-linear models, sample coverage, and ecological models, to obtain a comprehensive view of under-ascertainment bias in these populations. RESULTS All three approaches indicated differential undercount of ALS cases with modest under-ascertainment likely to have occurred among non-deployed military personnel, but little under-ascertainment among the deployed. After correcting the rates for under-ascertainment, the age-adjusted risk of ALS remained elevated among military personnel who had been deployed to S.W. Asia during the 1991 Gulf War, confirming the earlier report. CONCLUSIONS Capture-recapture methods are a useful approach to assessing the magnitude of case ascertainment bias in epidemiological studies from which ascertainment-adjusted estimates of rates and relative risks can be calculated.
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Affiliation(s)
- Cynthia J Coffman
- Institute for Clinical and Epidemiological Research, Biostatistics Unit, Durham VA Medical Center, Durham, NC 27705, USA.
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Herlitz J, Karlson BW, Sjölin M, Lindquist J. Ten-year mortality for patients discharged after hospitalization for chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to hospital discharge diagnosis. J Intern Med 2002; 251:526-32. [PMID: 12028508 DOI: 10.1046/j.1365-2796.2002.00994.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To describe the 10-year prognosis for patients discharged after hospitalization for chest pain or other symptoms giving an initial suspicion of acute myocardial infarction (AMI) in relation to the final hospital diagnosis and furthermore to compare the outcome amongst these patients with the outcome amongst a sex-, age- and community-matched control population. METHODS All patients who were hospitalized because of chest pain or other symptoms raising a suspicion of AMI and who were discharged alive from hospital. Patients were divided into three groups according to the final diagnosis: (1) confirmed or possible AMI, (2) confirmed or possible myocardial ischaemia and (3) other aetiology. Information on 10-year mortality was available in 3103 patients. A sex-, age- and community-matched control population (n=3221) was compared with the study population in terms of 10-year mortality. TIME OF SURVEY: 15 February 1986 to 9 November 1987. SETTING Sahlgrenska University Hospital. RESULTS Patients with confirmed or possible AMI (n=849) had a significantly higher mortality (59.4%) than patients with confirmed or possible myocardial ischaemia (n=1191) who had a mortality of 49.5% (P < 0.0001). The latter group had a higher mortality than patients with 'other aetiology' (n=1063) of whom 40.6% died (P < 0.0001). When comparing the prognosis for patients with AMI and myocardial ischaemia, there was a significant interaction with sex, with a more marked difference in women than in men. Amongst all patients, the 10-year mortality was 49.1 vs. 37.3% in the control group (P < 0.0001). CONCLUSION The very long term prognosis was strongly associated with diagnosis amongst patients hospitalized and discharged alive because of chest pain or other symptoms raising suspicion of AMI. The absolute mortality difference between patients who were discharged from hospital with confirmed diagnosis of AMI and those whose symptoms were considered to have other aetiology than AMI or ischaemia was nearly 20%. However, the absolute mortality difference between the patients included in the survey and a control population was only 12%.
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Affiliation(s)
- J Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Andersson M, Holmquist B, Lindquist J, Nilsson O, Wahlund KG. Analysis of film coating thickness and surface area of pharmaceutical pellets using fluorescence microscopy and image analysis. J Pharm Biomed Anal 2000; 22:325-39. [PMID: 10719916 DOI: 10.1016/s0731-7085(99)00289-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A method is presented which enables geometrical characterisation of pharmaceutical pellets and their film coating. It provides a high level of details on the single pellet level. Image analysis was used to determine the coating thickness (h) applied on the pellets and the surface area (A) of the pellet cores. Different definitions of A and h are evaluated. Hierarchical analysis of variance was used to resolve different sources contributing to the total variance. The variance within pellets and the variance between pellets were found as significant sources of variation. Special emphasis was put on evaluation of A/h due to its influence on the release rate of an active drug substance from the pellet core. The pellet images were thus used to predict variations in the release rate using a mathematical model as a link between the image data and the release rate. General aspects of image analysis are discussed. The method would be useful in calibration of near infrared spectra to h in process analytical chemistry.
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Affiliation(s)
- M Andersson
- Department of Technical Analytical Chemistry, Centre for Chemistry and Chemical Engineering, Lund University, Sweden
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Stefanovic B, Lindquist J, Brenner DA. The 5' stem-loop regulates expression of collagen alpha1(I) mRNA in mouse fibroblasts cultured in a three-dimensional matrix. Nucleic Acids Res 2000; 28:641-7. [PMID: 10606666 PMCID: PMC102518 DOI: 10.1093/nar/28.2.641] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/1999] [Revised: 11/02/1999] [Accepted: 11/18/1999] [Indexed: 11/13/2022] Open
Abstract
The stability of collagen alpha1(I) mRNA is regulated by its 5' stem-loop, which binds a cytoplasmic protein in a cap-dependent manner, and its 3'-untranslated region (UTR), which binds alphaCP. When cultured in a three-dimensional gel composed of type I collagen, mouse fibroblasts had decreased collagen alpha1(I) mRNA steady-state levels, which resulted from a decreased mRNA half-life. In cells cultured in gel, hybrid mouse-human collagen alpha1(I) mRNA with a wild-type 5' stem-loop decayed faster than the same mRNA with a mutated stem-loop. When the 5' stem-loop was placed in a heterologous mRNA, the mRNA accumulated to a lower level in cells grown in gel than in cells grown on plastic. This suggests that the 5' stem-loop down-regulates collagen alpha1(I) mRNA. Protein binding to the 5' stem-loop was reduced in cells grown in gel, which was associated with destabilization of the collagen alpha1(I) mRNA. In addition to the binding of a cytoplasmic protein, there was also a nuclear binding activity directed to the collagen alpha1(I) 5' stem-loop. The nuclear binding was increased in cells grown in gel, suggesting that it may negatively regulate expression of collagen alpha1(I) mRNA. Binding of alphaCP, a protein involved in stabilization of collagen alpha1(I) mRNA, was unchanged by the culture conditions.
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Affiliation(s)
- B Stefanovic
- Department of Medicine, University of North Carolina at Chapel Hill, CB 7038, Chapel Hill, NC 27599, USA
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Lindquist J. Prenatal testing: a thoughtful perspective. Midwifery Today Int Midwife 1999:37-9. [PMID: 10338560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lindquist J. [The myth about the lonely intern in the emergency department]. Lakartidningen 1993; 90:3742. [PMID: 7748240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Ostach W, Clevert HD, Lindquist J, Rohleder-Telkamp B. Conversion operation Billroth II into Billroth I with jejunal interposition. Helv Chir Acta 1991; 57:709-11. [PMID: 1864738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
First, under consideration of the erroneous operative often techniques often found in patients with B II gastrectomy, all functional complaints of these patients should prompt the consultant to recommend conversion surgery. Secondly, all recurrent ulcerations, whether peptic or anastomositis, represent an indication for conversion surgery. Last but not least reconstruction of normal nutrition passage in an important indication for surgery in patients with B II gastrectomy, restoring near physiologic passage circumstances. Particularly grave in its consequences is the gastric stump carcinoma with its fateful and irrevocable course for patients with B II gastrectomy if regular gastroscopic and laboratory follow-up inspection do not take place (regardless of questionable operation indication). We recall a tragic case of a woman with B II gastrectomy who refused conversion surgery despite histologic verification of metaplasia, who died of gastric stump carcinoma a year later.
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Affiliation(s)
- W Ostach
- German Red Cross Hospital Mark Brandenburg, Department for Surgery, Berlin
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Abstract
The degradation products of pralidoxime chloride (1) (X- = Cl-) in concentrated aqueous solutions (less than or equal to 50% w/v) were identified using one or more methods: HPLC, polarography, voltammetry, MS and/or NMR. The products found were the 2-cyano-, 2-carboxamido- and 2-carboxy-1-methyl-pyridinium chlorides, 1-methyl pyridinium chloride, cyanide ion, ammonia and carbon dioxide. 1-Methyl-2-pyridone was indirectly identified by the presence of cyanide ion. The degradation rate increased with increasing pH values between pH 1 and 3.2 and with increasing concentrations between 1 and 50% w/v pralidoxime chloride. The results suggest that 1 (X- = Cl-) is dehydrated by a hydroxyl-ion catalyzed reaction ot the nitrile 2 which is hydrolyzed to either the pyridone 6 and cyanide ion or to 2-carboxamido-1-methyl-pyridinium chloride 3. The amide is hydrolyzed to give the 2-carboxy derivative 4 which finally is decarboxylated to give 1-methylpyridinium chloride 5.
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Abstract
Proximal renal tubular function was studied in 11 patients with severe burn injury. Creatinine clearance was normal or increased in ten patients. Fractional excretion of sodium was less than 1% in ten. Fractional excretion of uric acid and amylase were increased in all but four and two cases, respectively, while absolute clearances of lysozyme and beta 2-microglobulin were increased in all but one patient. Renal threshold phosphate concentration was reduced in four patients. Twenty-four-hour urine glucose excretion exceeded 1 g in five patients, aminoaciduria was noted in eight, and proteinuria, predominantly globulinuria, was present consistently. Metabolic acidosis was seen in one patient, and transient hypokalemia occurred in two. Abnormalities of proximal tubular function were more marked in the five patients with the greatest extent of third-degree burns who died. The cause of proximal tubular dysfunction is not clear and may be related to an adaptive response to severe injury.
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Lindquist J. Determination of water in penicillins using fast Karl Fischer reagents and electronic end-point optimization. J Pharm Biomed Anal 1984; 2:37-44. [PMID: 16867763 DOI: 10.1016/0731-7085(84)80087-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/1983] [Indexed: 11/28/2022]
Abstract
When using conventional Karl Fischer reagents for titration of water in penicillins, decomposition products (i.e. penicilloic acid) are shown to be partly cotitrated. Water in ampicillin, bacampicillin, carboxybenzylpenicillin and cloxacillin was titrated with slow and fast reagents and the differences in the results obtained were compared with the content of penicilloic acid determined mercurimetrically. A simple electronic control unit has been developed to optimize the speed of titration.
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Affiliation(s)
- J Lindquist
- Astra Läkemedel AB, Research and Development Laboratories, Pharmaceutical Analysis, S-15185 Södertälje, Sweden
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Abstract
Theory and practice of an optical ambiguity processor based on space-variant joint Fourier transform holography are presented. The approach evolves from the joint Fourier transform optical correlator concept, which represents a different technique of implementing the matched filter correlator concept advanced by Vander Lugt. Experimental demonstration using photographic film for signal recording and the thermoplastic device for hologram recording will be reported.
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Bingham HG, Lindquist J. Does an intensive care burn unit really make a difference. J Fla Med Assoc 1977; 64:321-3. [PMID: 859008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Atuma SS, Lundström K, Lindquist J. The electrochemical determination of vitamin A. Part II. Further voltammetric determination of vitamin A and initial work on the determination of vitamin D in the presence of vitamin A. Analyst 1975; 100:827-34. [PMID: 929 DOI: 10.1039/an9750000827] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Atuma SS, Lindquist J, Lundström K. The electrochemical determination of vitamin A. I. Voltammetric determination of vitamin A in pharmaceutical preparations. Analyst 1974; 99:683-9. [PMID: 4457012 DOI: 10.1039/an9749900683] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hodges D, Lindquist J, Nelson B, Swallow E, Schwartz D. Application of the Alice flying spot digitizing system to oscilloscope and spark chamber data. ACTA ACUST UNITED AC 1973. [DOI: 10.1016/0029-554x(73)90537-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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