Perceptions of Assistive Technology Education From Occupational Therapists Certified as Assistive Technology Professionals.

Importance: Missing from the recent literature is information about specific categories of assistive technology (AT) education provided in entry-level occupational therapy curricula.

Objective: To examine occupational therapists' perceptions of the AT education received in occupational therapy entry-level programs, specifically the AT categories in which therapists received training.

Design: Quantitative survey study with Likert-scale, multiple-choice, or ordinal ranking-scale questions and three open-response questions.

The Multiple Sclerosis Surveillance Registry: A Novel Interactive Database Within the Veterans Health Administration.

Objective: To demonstrate the infrastructure and utility of an interactive health system database for multiple sclerosis (MS), we present the MS Surveillance Registry (MSSR) within the US Department of Veterans Affairs (VA).

Background: Disease specific databases can be helpful in the management of neurologic conditions but few are fully integrated into the electronic health record and linked to health system data. Creating a consistent information technology (IT) architecture and with ongoing support within disease specific registries has been a challenge.

Individuality of the plasma sodium concentration.

Older literature has suggested that the plasma sodium concentration is not individual, that it is neither intrinsic to an individual nor reproducible, longitudinally. We recently observed that the plasma sodium concentration is heritable. Because demonstrable heritability requires individuality of the relevant phenotype, we hypothesized that the plasma sodium concentration was substantially individual.

Comparison of health service use among veterans with methamphetamine versus alcohol use disorders.

Objectives: Methamphetamine use disorders (MUD) are associated with severe health effects and psychiatric comorbidities, but little is known about the health care utilization of patients with MUD. The goal of this study was to describe health service use among veterans with MUD relative to a group of veterans with an alcohol use disorder (AUD).

Methods: Using Veterans Affairs (VA) administrative data, we identified 718 patients who were diagnosed with MUD and had confirmatory drug testing.

Treatment receipt and outcomes among lung cancer patients with depression.

Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer.

Materials And Methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010.

Sex differences in the medical care of VA patients with chronic non-cancer pain.

Objective: Despite a growing number of women seeking medical care in the veterans affairs (VA) system, little is known about the characteristics of their chronic pain or the pain care they receive. This study sought to determine if sex differences are present in the medical care veterans received for chronic pain.

Design: Retrospective cohort study using VA administrative data.

Complications after surgery for lumbar stenosis in a veteran population.

Study Design: Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database.

Objective: Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications.

Summary Of Background Data: Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients.

Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain.

Objectives: Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain.

Methods: Using Veterans Affairs administrative data, we identified 5961 veterans from the Pacific Northwest with persistent elevated pain intensity scores who had not been prescribed opioids in the prior 12 months.

The effects of age on initiation of mental health treatment after positive PTSD screens among Veterans Affairs primary care patients.

Objective: The objective was to examine differences by age in mental health treatment initiation in Veterans Health Administration (VA) primary care patients after positive posttraumatic stress disorder (PTSD) screens.

Methods: This was a retrospective cohort study of 71,039 veterans who were administered PTSD screens during primary care encounters in 2007 at four Pacific Northwest VA medical center sites and who had no specialty mental health clinic visits or PTSD diagnoses recorded in the year before screening. Main outcome measures were attendance of any specialty mental health clinic visits or receipt of any antidepressant medication in the year after a positive PTSD screen.

Delirium and decisional incapacity in veterans with schizophrenia and medical illness.

Objective: The objective was to examine the characteristics of Veterans with schizophrenia admitted for nonpsychiatric hospitalizations.

Method: We conducted a review of the electronic medical record and data warehouse downloads of Veterans with schizophrenia admitted to nonpsychiatric services of a large, academic Veterans Affairs hospital between 2004 and 2009 on whom psychiatry was consulted.

Results: Seventy-four veterans were admitted 89 times.

Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry.

Purpose: Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited.

Patients And Methods: We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor.

Patterns and correlates of prescription opioid use in OEF/OIF veterans with chronic noncancer pain.

Objectives: Little is known about the treatment Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans receive for chronic noncancer pain (CNCP). We sought to describe the prevalence of prescription opioid use, types, and doses of opioids received and to identify correlates of receiving prescription opioids for CNCP among OEF/OIF veterans.

Design: Retrospective review of Veterans Affairs (VA) administrative data.

Correlates of utilization of PTSD specialty treatment among recently diagnosed veterans at the VA.

Objectives: This study described utilization of specialty treatment for posttraumatic stress disorder (PTSD) at U.S. Department of Veterans Affairs (VA) facilities among veterans of Operation Enduring Freedom (OEF), in Afghanistan, or of Operation Iraqi Freedom (OIF), in Iraq, and non-OEF-OIF veterans recently diagnosed as having PTSD.

Adherence to clinical guidelines for opioid therapy for chronic pain in patients with substance use disorder.

Background: Patients with chronic non-cancer pain (CNCP) have high rates of substance use disorders (SUD). SUD complicates pain treatment and may lead to worse outcomes. However, little information is available describing adherence to opioid treatment guidelines for CNCP generally, or guideline adherence for patients with comorbid SUD.

Clinical characteristics of veterans prescribed high doses of opioid medications for chronic non-cancer pain.

Little is known about patients prescribed high doses of opioids to treat chronic non-cancer pain, though these patients may be at higher risk for medication-related complications. We describe the prevalence of high-dose opioid use and associated demographic and clinical characteristics among veterans treated in a VA regional healthcare network. Veterans with chronic non-cancer pain prescribed high doses of opioids (≥ 180 mg/day morphine equivalent; n=478) for 90+ consecutive days were compared to two groups with chronic pain: Traditional-dose (5-179 mg/day; n=500) or no opioid (n=500).

End-of-life care for veterans with schizophrenia and cancer.

Objective: This study compared the quality of end-of-life care between veterans with and without schizophrenia who died of cancer in the northwestern United States.

Methods: In this cross-sectional study, medical records of 60 veterans with schizophrenia and 196 with no major mental illness who died of cancer were compared on hospice enrollment, palliative and life-sustaining interventions, advance directives, and site of death.

Results: Among veterans with schizophrenia, 58% had an advance directive, 73% received an opiate before hospice enrollment, 63% had a physician order to forgo cardiopulmonary resuscitation, 55% were hospice enrolled, and 27% died in the hospital.

VA healthcare costs of a collaborative intervention for chronic pain in primary care.

Background: Chronic pain is costly to individuals and the healthcare system, and is often undertreated. Collaborative care models show promise for improving treatment of patients with chronic pain. The objectives of this article are to report the incremental benefit and incremental health services costs of a collaborative intervention for chronic pain from a veterans affairs (VA) healthcare perspective.

Operational evaluation of high-throughput community-based mass prophylaxis using Just-in-time training.

Community-based mass prophylaxis is a core public health operational competency, but staffing needs may overwhelm the local trained health workforce. Just-in-time (JIT) training of emergency staff and computer modeling of workforce requirements represent two complementary approaches to address this logistical problem. Multnomah County, Oregon, conducted a high-throughput point of dispensing (POD) exercise to test JIT training and computer modeling to validate POD staffing estimates.

An evaluation of the Baltimore Community Lead Education and Reduction Corps (CLEAR Corps) program.

This evaluation examines the effectiveness of the Baltimore Community Lead Education and Reduction Corps (CLEARCorps) program in reducing lead dust levels in low-income urban housing in Baltimore, Maryland, through minor lead-reduction activities and tenant lead-poisoning prevention education. Lead dust data collected before and after lead-reduction activities show statistically significant mean declines for floors, window sills, and window wells. Limited data using tests also show that follow-up lead dust levels collected 6 months after the CLEARCorps intervention were significantly lower than preintervention lead levels.