Impact of the COVID-19 pandemic on the rate of lower limb amputation in Veterans.

Background: The COVID-19 pandemic led to changes in health care, including postponement of nonurgent appointments. These changes, combined with overall decreased activity levels, may have placed individuals with vascular disease at increased risk for skin ulceration and amputation.

Objective: To determine the rates of lower limb amputation in Veterans due to complications of diabetes and/or vascular disease in the year following onset of the COVID-19 pandemic (March 2020-March 2021) compared to the previous 3 years (March 2017-March 2020).

Veteran Perspectives on Phantom Limb Pain and Non-Drug Interventions.

Background: Phantom limb pain (PLP) commonly occurs post-amputation and can negatively affect the daily functioning of persons with amputation. Best practices for medication and non-drug management remain unclear.

Objective: To better understand the PLP experience and patients' familiarity with treatments, phone interviews were conducted at the Minneapolis Veterans Affairs Regional Amputation Center in Veterans with amputations.

Decreased antimicrobial prescribing rate following academic detailing of resident physicians in outpatient clinic.

Among 37 internal-medicine resident physicians assigned to our outpatient clinic at Minneapolis Veterans' Affairs Health Care System (MVAHCS) on July 1, 2017, we designed a pre- and postintervention observational study. Our results show that in-person academic detailing around outpatient antimicrobial selection was associated with a decrease in outpatient antimicrobial prescriptions in a group of high-prescribing resident physicians.

A Consensus Diagnosis Utilizing Surface KI-67 Expression as an Ancillary Marker in Low-Grade Dysplasia Helps Identify Patients at High Risk of Progression to High-Grade Dysplasia and Esophaegal Adenocarcinoma.

Esophageal adenocarcinoma (EAC) develops in a step-wise manner, from low-grade dysplasia (LGD) to high-grade dysplasia (HGD), and ultimately to invasive EAC. However, there remains diagnostic uncertainty about LGD and its risk of progression to HGD/EAC. The aim is to investigate the role of Ki-67, immune-histochemical marker of proliferation, surface expression in patients with confirmed LGD, and risk stratify progression to HGD/EAC.

Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.

Introduction: Femoral head collapse (FHC) is a rarely reported complication of hip intra-articular corticosteroid injection (IACSI). Upon observing a high rate of FHC after hip IACSI, we sought to (1) describe how we addressed the problem through a systematic evaluation of clinical data and institutional care practices followed by process improvement efforts; and (2) report our results.

Methods: Patients receiving hip IACSI during a 27-month period underwent retrospective review to determine the rate of FHC and to identify associated patient factors or practice shortfalls.

CX-4945 and siRNA-Mediated Knockdown of CK2 Improves Cisplatin Response in HPV(+) and HPV(-) HNSCC Cell Lines.

Head and neck squamous cell carcinoma (HNSCC) can be categorized into human papillomavirus (HPV) positive or negative disease. Elevated protein kinase CK2 level and activity have been historically observed in HNSCC cells. Previous studies on CK2 in HNSCC did not generally include consideration of HPV(+) and HPV(-) status.

Persistent indefinite for dysplasia in Barrett's esophagus is a risk factor for dysplastic progression to low-grade dysplasia.

Patients with Barrett's esophagus (BE) are at increased risk of esophageal adenocarcinoma (EAC). The risk is largely based on the degree of dysplasia. Dysplasia cannot always be differentiated from inflammatory changes, and therefore may be classified as indefinite for dysplasia (IND).

NT-Pro BNP Predicts Myocardial Injury Post-vascular Surgery and is Reduced with CoQ: A Randomized Double-Blind Trial.

Background: NT-Pro BNP levels provide incremental value in perioperative risk assessment prior to major noncardiac surgery. Whether they can be pharmacologically modified in patients prior to an elective vascular operation is uncertain.

Methods: A double-blind, randomized controlled trial was implemented at a single institution.

Patient Satisfaction With Medical Student Participation in a Longitudinal Integrated Clerkship: A Controlled Trial.

Purpose: To determine whether longitudinal student involvement improves patient satisfaction with care.

Method: The authors conducted a satisfaction survey of patients followed by 10 University of Minnesota Medical School students enrolled in 2016-2017 in the Veterans Affairs Longitudinal Undergraduate Medical Education (VALUE) program, a longitudinal integrated clerkship at the Minneapolis Veterans Health Care System. Students were embedded in an ambulatory practice with primary preceptors who assigned students a panel of 14 to 32 patients to follow longitudinally in inpatient and outpatient settings.

Younger Physicians and Longer Withdrawal Times Are Associated With Detection of Advanced Neoplasia in a Large Community Practice.

Studies assessing colonoscopic practice have demonstrated variation in adenoma detection rate, detection rates of advanced adenomas, and detection rates of sessile serrated lesions (SSLs). Our aims were to study the patient-, provider-, and procedure-level variables associated with detection rates of adenoma, SSLs, and advanced neoplasia in screening colonoscopies performed in large community practice.

Decreased warfarin sensitivity among patients treated with elbasvir and grazoprevir for hepatitis C infection.

Purpose: We previously reported an interaction with warfarin anticoagulation when initiating treatment with direct-acting antiviral agents for hepatitis C infection. A decreased warfarin sensitivity led to subtherapeutic anticoagulation. To study this interaction further, we expanded our research to include patients treated with the combination of elbasvir and grazoprevir concurrent with warfarin anticoagulation and investigated changes in warfarin sensitivity during and after treatment.

Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results.

Background: Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening.

Methods: In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records.

Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans.

We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP.

Reliability of store and forward teledermatology for skin neoplasms.

Background: Teledermatology may be less optimal for skin neoplasms than for rashes.

Objectives: We sought to determine agreement for skin neoplasms.

Methods: This was a repeated measures study.

Racial differences in prescription of opioid analgesics for chronic noncancer pain in a national sample of veterans.

Unlabelled: The purpose of this study was to investigate possible racial differences in opioid prescriptions among primary care patients with chronic noncancer pain receiving care in the Veterans Affairs health care system. This was a retrospective cohort study of 99,903 veterans with diagnoses of low back, neck, or joint pain selected to participate in the Veterans Affairs Survey of the Healthcare Experiences of Patients in fiscal year 2006. The outcome was prescription of opioids in the year following the first pain diagnosis, obtained through electronic medical record data.

Adding Postal Follow-Up to a Web-Based Survey of Primary Care and Gastroenterology Clinic Physician Chiefs Improved Response Rates but not Response Quality or Representativeness.

This study assessed whether postal follow-up to a web-based physician survey improves response rates, response quality, and representativeness. We recruited primary care and gastroenterology chiefs at 125 Veterans Affairs medical facilities to complete a 10-min web-based survey on colorectal cancer screening and diagnostic practices in 2010. We compared response rates, response errors, and representativeness in the primary care and gastroenterology samples before and after adding postal follow-up.

A national study of racial differences in pain screening rates in the VA health care system.

Objectives: To determine whether black patients are less likely to be screened for pain than white patients.

Participants: A sample of 25,382 black and 220,122 non-Hispanic white Veterans Affairs (VA) patients was identified among the panel surveyed in the ambulatory care module of the 2007 Survey of Health Care Experiences of Patients.

Design: This was a cross-sectional analysis of documentation of a pain score in the electronic medical record at the patient's Survey of Health Care Experiences of Patients index visit.

Caregiver reports of subsequent injuries among veterans with traumatic brain injury after discharge from inpatient polytrauma rehabilitation programs.

Objective: : We examined prevalence of, and potential risk factors for, nonfatal injuries among Veterans with traumatic brain injury (TBI) postdischarge from Veterans Affairs inpatient polytrauma rehabilitation programs.

Methods: : We surveyed caregivers of patients who had military service anytime from 2001 to 2009, sustained polytrauma including TBI, received Veterans Affairs inpatient care from 2001 to 2009, were discharged at least 3 months before the study, and were alive when the study was fielded about caregiver and patient health, including patients' medically treated "accidents/new injuries" since discharge. We examined prevalence and source(s) of subsequent injuries and estimated patients' injury risk in reference to hypothesized risk factors.

Post-deployment injury among new combat veterans enrolled in Veterans Affairs (VA) healthcare.

The purpose of this study was to examine prevalence and potential risk factors for post-deployment injury among Iraq and Afghanistan combat veterans enrolled in Veterans Affairs (VA) healthcare. A national, stratified sample of Iraq/Afghanistan combat Veteran VA users was surveyed in 2008. Mental and physical health, including medically-treated injuries sustained since deployment, were self-reported.