Veterans Health Administration Outpatient Psychiatry Staffing Model: Longitudinal Analysis on Mental Health Performance.

Background: An adequate supply of mental health (MH) professionals is necessary to provide timely access to MH services. Veterans Health Administration (VHA) continues to prioritize the expansion of the MH workforce to meet increasing demand for services.

Objective: Validated staffing models are essential to ensure timely access to care, to plan for future demand, to ensure delivery of high-quality care, and to balance the demands of fiscal responsibility and strategic priorities.

Over-prescription of short-acting β-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study.

Background: The extent of short-acting β-agonist (SABA) overuse in Africa remains poorly documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions/clinical outcomes in 3 African countries.

Methods: Data on disease characteristics/asthma treatments were collected from patients (≥12 years) using electronic case report forms.

Outpatient provider staffing ratios: Binary recursive models associated with quality, access, and satisfaction.

Veterans Health Administration (VHA) continues to expand the mental health (MH) workforce to meet increasing demand for services. In the present study, longitudinal unbiased recursive partitioning models (conditional inference trees) were created to identify optimal cutoffs for outpatient staffing ratios associated with success on VHA's measures of quality, access, and satisfaction. Quarterly Staff-to-Patient Ratios (SPRs), defined as the number of full-time equivalent providers per 1,000 veterans receiving outpatient mental health care, were calculated for 12 quarters from fiscal years 2016-2018.

Investigation of population-based mental health staffing and efficiency-based mental health productivity using an information-theoretic approach.

Background: Healthcare systems monitor and improve mental health treatment quality, access, continuity and satisfaction through use of population-based and efficiency-based staffing models, the former focused on staffing ratios and the latter, staff productivity. Preliminary evidence suggests that both high staffing ratios and moderate-to-high staff productivity are important for ensuring a full continuum of mental health services to indicated populations.

Methods & Findings: With an information-theoretic approach, we conducted a longitudinal investigation of mental health staffing, productivity and treatment at the largest integrated healthcare system in American, the Veterans Health Administration (VHA).

Virtual mental health care in the Veterans Health Administration's immediate response to coronavirus disease-19.

The coronavirus disease 2019 (COVID-19) pandemic has increased the need for psychological care in the global population and has created new barriers to accessing services. Hospitals, mental health facilities, and other clinics face the challenge of providing continued care to a population that is under severe stress, while minimizing in-person visits that risk spreading the virus. The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, providing care at 1,286 sites.

Recommendations for lung cancer screening in Southern Africa.

Lung cancer remains the leading cause of cancer-related deaths in southern Africa. Early trials of chest radiograph-based screening in males at high risk for lung cancer found no mortality benefit of a radiograph alone, or a radiograph plus sputum cytology screening strategy. Large prospective studies, including the National Lung Screening Trial, have shown an all-cause mortality benefit when low-dose computed tomography (LDCT) was used as a screening modality in patients that are at high risk of developing lung cancer.

Mental Health Treatment Quality, Access, and Satisfaction: Optimizing Staffing in an Era of Fiscal Accountability.

Objective: Mental health treatment access and quality are influenced by the interplay of structural, organizational, and performance factors-including the number of mental health staff providing direct clinical care relative to patients treated (i.e., staffing ratio), mental health staff productivity, and wait times for scheduled mental health appointments.

Erratum to South African guideline for the management of community-acquired pneumonia in adults.

[This corrects the article DOI: 10.21037/jtd.2017.

Mental health productivity monitoring in the Veterans Health Administration: Challenges and lessons learned.

Achieving quality outcomes and cost efficiency within mental health are overarching objectives of the Veterans Health Administration (VHA). The mental health care workforce has long been oriented toward the goal of high quality outcomes; however, cost efficiency has only recently been elevated into this important value equation. With increased demand for access to mental health services within the VHA, leadership sought to advance methods of determining and improving mental health provider productivity.

Capturing Psychologists' Work in Integrated Care: Measuring and Documenting Administrative Outcomes.

With the expansion of integrated primary care and the increased focus on fiscal sustainability, it is critical for clinical managers of these innovative systems to have practical methods for measuring administrative outcomes. Administrative outcomes will assist leadership in the development of efficient, streamlined clinics to provide services to the primary care population. Additionally, administrative measures can be utilized to provide information to assist in guiding resource utilization and management decisions.

Understanding and managing the impact of HPMC variability on drug release from controlled release formulations.

The purpose of this study is to identify critical physicochemical properties of hydroxypxropyl methylcellulose (HPMC) that impact the dissolution of a controlled release tablet and develop a strategy to mitigate the HPMC lot-to-lot and vendor-to-vendor variability. A screening experiment was performed to evaluate the impacts of methoxy/hydroxypropyl substitutions, and viscosity on drug release. The chemical diversity of HPMC was explored by nuclear magnetic resonance (NMR), and the erosion rate of HPMC was investigated using various dissolution apparatuses.

Microsatellite loci in Ipomopsis aggregata (Polemoniaceae) and cross-species applicability for ecological genetics studies.

Premise Of The Study: Novel microsatellite primers were developed for the native wildflower Ipomopsis aggregata to facilitate ongoing studies of the genetics of local adaptation and patterns of hybridization with closely related species within the genus.

Methods And Results: Thirteen primer sets were successfully developed and tested using populations from the Rocky Mountains of Colorado, USA. The primers amplified di-, tri-, and tetranucleotide repeats with 1-15 alleles per locus.

A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction.

Charcot foot syndrome (Charcot neuroarthropathy affecting the foot), particularly in its latter stages, may pose a significant technical challenge to the surgeon. Because of the lack of anatomic consistency, preoperative planning with virtual and physical models of the foot could improve the chances of achieving a predictable intraoperative result. In this report, we describe the use of a novel, inexpensive, 3-dimensional template printing technique that can provide, with just a normal printer, multiple "copies" of the foot to be repaired.

Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV- women: the Women's Interagency HIV Study (WIHS) Neurocognitive Substudy.

Use of neuropsychological tests to identify HIV-associated neurocognitive dysfunction must involve normative standards that are well suited to the population of interest. Norms should be based on a population of HIV-uninfected individuals as closely matched to the HIV-infected group as possible and must include examination of the potential effects of demographic factors on test performance. This is the first study to determine the normal range of scores on measures of psychomotor speed and executive function among a large group of ethnically and educationally diverse HIV-uninfected, high-risk women, as well as their HIV-infected counterparts.

Comparison of Wechsler Memory Scale-Fourth Edition (WMS-IV) and Third Edition (WMS-III) dimensional structures: improved ability to evaluate auditory and visual constructs.

Dimensional structures underlying the Wechsler Memory Scale-Fourth Edition (WMS-IV) and Wechsler Memory Scale-Third Edition (WMS-III) were compared to determine whether the revised measure has a more coherent and clinically relevant factor structure. Principal component analyses were conducted in normative samples reported in the respective technical manuals. Empirically supported procedures guided retention of dimensions.

Immunotoxicity testing in nonhuman primates.

Biological relevance is generally the major justification for using nonhuman primates (NHP) during preclinical safety assessment. This holds particularly true for the evaluation of biopharmaceuticals with NHP often being the species of choice. For safety assessment of small molecules, NHP are used in case of a higher degree of metabolic similarity, to detect the highly specific immunotoxic side effects and to discriminate toxicity from efficacy of immunomodulatory drugs.

White matter anisotropy and depression symptoms in patients with HIV.

HIV is associated with increased risk for depression. Normal appearing white matter (NAWM) fractional anisotropy in 15 HIV-seropositive (HIV+) adults with depressive symptoms was compared to 15 HIV+ adults without depressive symptoms. HIV+ adults with depressive symptoms showed increased NAWM fractional anisotropy within the left thalamus, the temporal, and frontal regions, as well as the right cingulate.

HIV-associated alterations in normal-appearing white matter: a voxel-wise diffusion tensor imaging study.

Objective: There are conflicting reports of adverse HIV-associated alterations in white matter integrity as measured by diffusion tensor imaging (DTI). We sought to address these conflicting reports by assessing, on a voxel-by-voxel basis, HIV-associated regional changes in radiologically defined normal-appearing white matter (NAWM) integrity using high-resolution DTI.

Methods: 30 HIV-seropositive (SP) and 30 HIV-seronegative (SN) nondemented, community-dwelling participants underwent DTI to derive whole-brain measures of white matter integrity (fractional anisotropy [FA] and mean diffusivity [MD]).

The MMPI-2 Fake Bad Scale: concordance and specificity of true and estimated scores.

A number of recent studies have supported the use of the MMPI-2 Fake Bad Scale (FBS) as a measure of negative response bias, the scale at times demonstrating greater sensitivity to negative response bias than other MMPI-2 validity scales. However, clinicians may not always have access to True FBS (T-FBS) scores, such as when True-False answer sheets are unavailable or published research studies do not report FBS raw scores. Under these conditions, Larrabee (2003a) suggests a linear regression formula that provides estimated FBS (E-FBS) scores derived from weighted validity and clinical T-Scores.

The pattern of neuropsychological deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND).

We examined the pattern of neuropsychological deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND) by comparing the cognitive and behavioral performance of 41 post-stroke Vascular CIND patients to that of 62 post-stroke patients with no cognitive impairment (NCI). Neuropsychological test scores were grouped into seven cognitive and four behavioral domains, then converted to standardized, weighted principle component scores (PCS) for each domain. Multivariate logistic regression models built on cognitive domains found the immediate recall and psychomotor domains to best predict diagnostic group membership.