Diagnosing Chronic Obstructive Pulmonary Disease Among Afghanistan and Iraq Veterans: Veterans Affair's Concordance With Clinical Guidelines for Spirometry Administration.

Background: Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) can slow disease progression. The Department of Veterans Affairs (VA)/Department of Defense Clinical Practice Guidelines (CPG), established to improve patient outcomes, recommend the use of spirometry in the COPD diagnostic process. The aims of this study were to assess VA health care providers' performance related to CPG-recommended spirometry administration in the evaluation of newly diagnosed COPD among veterans, determine the patient characteristics that may influence the adherence rate, and compare VA concordance rates to those of other health plans.

Beyond research literature: Occupational therapists' perspectives on and uses of "evidence" in everyday practice.

Background: Recent literature in evidence-based practice indicates that evidence is defined differently from practice and research perspectives. However, few published works address therapists' perspectives of the nature and use of evidence in everyday practice.

Purpose: This study describes the definition, types, and use of evidence from the perspective of six school-based occupational therapists.

Health care utilization behavior of veterans who deployed to Afghanistan and Iraq.

Background: Previous assessments of Afghanistan/Iraq Veterans have lacked a systematic overview of all injury and illness experiences captured by the Veterans Health Administration (VHA) health care services. In this initial study, we quantify the health care utilization behavior of eligible Veterans and describe the level and type of usage among them.

Methods: A roster of service members who have served in Afghanistan/Iraq and became eligible for VHA care between 2002 and 2010 and their corresponding administrative VA medical encounter data were abstracted from the VHA Office of Public Health Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Health Surveillance System.

Features: Health Care Use Among Iraq and Afghanistan Veterans With Infectious Diseases.

Qualified veterans were no more likely to take advantage of health care services after the VA presumptive infectious disease determination streamlined the qualification process.

Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device.

Objective: It is generally accepted that patients who require biventricular assist device support have poorer outcomes than those requiring isolated left ventricular assist device support. However, it is unknown how the timing of biventricular assist device insertion affects outcomes. We hypothesized that planned biventricular assist device insertion improves survival compared with delayed conversion of left ventricular assist device support to biventricular assist device support.

Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support.

Background: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication and is difficult to predict. In the era of destination therapy and the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important.

Methods: We reviewed patient characteristics, laboratory values and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007.