Telehealth for Goals of Care Conversations in Advanced CKD: A Mixed-Methods Pilot Study of US Veterans and Their Clinicians.

Rationale & Objective: Engaging patients with advanced chronic kidney disease (CKD) in goals of care (GOC) conversations is essential to align life-sustaining treatments with patient preferences. This pilot study described the feasibility of engaging older Veterans with advanced CKD in GOC conversations via telehealth by (1) comparing patient characteristics, including life-sustaining treatment note completion rates and preferences by visit modality, and (2) exploring Veteran and clinician perspectives surrounding telehealth GOC conversations.

Study Design: Mixed-method convergent design including a prospective, quantitative observational cohort analysis (n = 40) and qualitative, semi-structured interviews with 4 clinicians and 11 Veterans.

Veteran patient perceptions of a universal gloving intervention for health care-associated infection prevention: A qualitative study.

Background: Universal gloving by health care workers (HCW) for all patient care activities (beyond isolation and standard precautions) has been proposed to reduce health care-associated infection transmission, but patient perceptions of this approach are unclear. We interviewed patients who experienced a universal gloving intervention by HCW within Veterans Affairs inpatient acute care units to understand their perceptions of universal gloving.

Methods: We conducted interviews with 15 patients across 5 Veterans Affairs hospitals.

A cross-sectional survey of Department of Veterans Affairs laboratory practices for identification of carbapenem-resistant and .

Control of carbapenem-resistant and spread in healthcare settings begins with timely and accurate laboratory testing practices. Survey results show most Veterans Affairs facilities are performing recommended tests to identify these organisms. Most facilities report sufficient resources to perform testing, though medium-complexity facilities report some perceived barriers.

Nephrology-Palliative Care Collaboration to Promote Outpatient Hemodialysis Goals of Care Conversations.

Background: Goals of care conversations and corresponding life-sustaining treatment (LST) progress notes were completed for only one-fourth of patients on outpatient dialysis despite hospital-wide training with nephrologists at the Edward Hines, Jr. Veterans Affairs Hospital. The purpose of this quality improvement project was to increase completion of LST progress notes and corresponding orders among patients on dialysis through an interdisciplinary nephrology-palliative care collaboration.

Age and beliefs about vaccines associated with COVID-19 vaccination among US Veterans.

This project surveyed Veterans' COVID-19 vaccination beliefs and status. 1,080 (30.8%) Veterans responded.

Antimicrobial stewardship strategy implementation and impact in acute care spinal cord injury and disorder units.

Context: Antimicrobial Stewardship Programs (ASPs) are crucial to optimizing antibiotic use. ASPs are implemented in the Veterans Health Administration (VAs), but they do not target the needs of populations at high risk for resistant infections, such as spinal cord injury and disorder (SCI/D).

Objective: The goal of this study was to assess key ASP leader and SCI/D clinicians' perceived level of implementation and impact of 33 Antimicrobial Stewardship (AS) strategies.

Differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant persons.

Acceptance of the COVID-19 vaccination becomes more critical as new variants continue to evolve and the United States (US) attempts to move from pandemic response to management and control. COVID-19 stands out in the unique way it has polarized patients and generated sustained vaccine hesitancy over time. We sought to understand differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant patients, with the goal of informing communication and implementation strategies to increase uptake of COVID-19 vaccines in Veteran and non-Veteran communities.

Malunions following lower extremity fractures in veterans with a spinal cord injury/disorder.

Background: Nearly 50% of all persons with a spinal cord injury/disorder (SCI/D) will sustain an osteoporotic fracture sometime in their life, with lower extremity fractures being the most common. There are a number of complications that can occur post fracture, including fracture malunion. To date, there have been no dedicated investigations of malunions among persons with SCI/D.

Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case-control study.

Study Design: This is a retrospective case-control study.

Objectives: To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI).

Setting: US Veterans Health Administration facilities (2005-2015).

Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury.

We used Veterans Health Administration (VHA) national administrative data files to identify a cohort (fiscal years 2005-2014) of veterans with spinal cord injuries and disorders (SCID) to determine risk factors for and consequences of lower extremity fracture nonunions. Odds ratios (OR) for fracture nonunion were computed using multivariable-adjusted logistic regression models. We identified three risk factors for nonunion: (i) older age (OR = 2.

"Pathological" fractures in spinal cord injuries and disorders: Insight into International classification of diseases, ninth revision coding.

Objective: Analyses of osteoporosis-related fractures in persons with Spinal Cord Injury or Disorder (SCID) using administrative data often exclude pathological fractures (International Classification of Diseases, Ninth Revision (ICD-9) codes 733.1x). We examined how often lower extremity "pathological" fractures were secondary to osteoporosis.

Lower extremity fracture prevention and management in persons with spinal cord injuries and disorders: The patient perspective.

Context/objective: To describe patient experiences with fracture prevention and management among persons with spinal cord injuries/disorders (SCI/D).

Design: Qualitative data collected via semi-structured telephone interviews.

Setting: Veterans Health Administration (VA) SCI/D System of Care.

Physical and occupational therapist rehabilitation of lower extremity fractures in veterans with spinal cord injuries and disorders.

Context/objective: The risk of lower extremity (LE) fractures in persons with spinal cord injury or disorders (SCI/D) is double that of the able-bodied population. LE fractures are the most common fracture location in SCI/D. Physical therapists (PTs) and occupational therapists (OTs) play an important role in rehabilitating LE fractures in Veterans with SCI/D.

Association of Bisphosphonate Therapy With Incident of Lower Extremity Fractures in Persons With Spinal Cord Injuries or Disorders.

Objective: To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID).

Design: Propensity-matched case-control analyses.

Setting: United States Veterans Affairs (VA) facilities.

Spinal cord injury providers' perspectives on managing sublesional osteoporosis.

Persons with spinal cord injuries (SCI) experience rapid sublesional bone loss following injury (1, 3). Evidence on preventing/managing osteoporosis in SCI is lacking. This project examined how providers manage bone loss in SCI.

Reasons for Initiation and Discontinuation of Pharmacological Therapies for Osteoporosis in Veterans with Spinal Cord Injury and Disorders.

Introduction: Medications for osteoporosis have not been reported to reduce fracture rates in patients with spinal cord injury and disorders (SCI/D), yet these medications are still prescribed. Clinical decision-making underscoring the initiation and discontinuation of osteoporosis medications in SCI/D remains poorly understood.

Methodology: Veterans with a SCI/D with at least one prescription for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, and teriparatide) who received healthcare within Veterans Affairs (VA) from 2005 to 2015 were identified using VA administrative databases.

Predicting osteoporosis medication receipt in Veterans with a spinal cord injury: A retrospective cohort study.

To describe frequency and predictors of use of pharmacological therapies for osteoporosis in persons with a spinal cord injury (SCI).: Retrospective cohort study. United States Veterans Health Administration (VA) national databases.

Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review.

The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D. Scoping review. Human adult subjects with a SCI/D.

Association of moral values with vaccine hesitancy.

Clusters of unvaccinated children are particularly susceptible to outbreaks of vaccine-preventable disease . Existing messaging interventions demonstrate short-term success, but some may backfire and worsen vaccine hesitancy . Values-based messages appeal to core morality, which influences the attitudes individuals then have on topics like vaccination .

A flexible influence of affective feelings on creative and analytic performance.

Considerable research shows that positive affect improves performance on creative tasks and negative affect improves performance on analytic tasks. The present research entertained the idea that affective feelings have flexible, rather than fixed, effects on cognitive performance. Consistent with the idea that positive and negative affect signal the value of accessible processing inclinations, the influence of affective feelings on performance on analytic or creative tasks was found to be flexibly responsive to the relative accessibility of different styles of processing (i.