Objective: The Veterans Health Administration (VHA) recently piloted the implementation of the TeleWound Practice Program (TWP), which provides interprofessional wound care to Veterans remotely. We assessed the perceptions of Veterans and healthcare team members (HCTMs), and their experiences with the TWP.
Method: We surveyed Veterans from four VHA medical centres who had received at least one TWP visit between 1 May 2020 and 31 May 2021, and HCTMs associated with any TWP encounter between 1 September 2019 and 31 March 2021.
Background: Electronic medical record (EMR)-based studies hold great potential for epidemiologic investigations of Parkinson's disease (PD) causal factors and phenomenology, but diagnostic misclassification may obscure or bias inferences.
Objectives: The aims were to determine the validity of PD diagnostic codes in the Veterans Administration (VA) national electronic medical databases and develop recommendations for maximizing ascertainment accuracy.
Methods: We investigated a cohort of 146,776 veterans who utilized VA healthcare between 1999 and 2021.
Endocrinol Metab Clin North Am
December 2024
Spinal cord injury (SCI) leads to significant bone loss resulting in osteoporosis and an increased risk of fractures below the level of injury. It is imperative to screen for osteoporosis in all individuals with SCI starting immediately after the acute injury. Although data are limited, clinicians are encouraged to discuss preventative treatment in the acute SCI period and to treat osteoporosis when diagnosed.
View Article and Find Full Text PDFContext: The growing number of females entering the armed forces has led to an increase in the number of female Veterans with spinal cord injury and diseases (SCI/D) requiring mobility devices. Limited research exists that explores whether mobility devices meet their needs in terms of comfort, fit and design.
Objective: To characterize respondents with SCI/D who use mobility devices and determine if these devices are meeting their daily needs.
Background: We recently reported an increased risk of Parkinson's disease (PD) in service members who resided at Marine Base Camp Lejeune, North Carolina, when water supplies were contaminated with trichloroethylene and other volatile organic compounds (VOCs). Prior studies suggest that environmental exposures may affect PD phenotype or progression, but this has not been reported for VOCs.
Objective: The objective of this study was to test whether PD progression is faster in individuals exposed to VOCs in water at Camp Lejeune.
Inappropriate urinary tract infection diagnosis in patients with neurogenic bladder may result from ambiguous symptoms experienced by these patients and contributes to antibiotic overuse. Characterization of patient-reported signs and symptoms may help providers more appropriately diagnose urinary tract infections. A previous study collected signs and symptoms recorded in electronic medical records of patients with neurogenic bladder due to spinal cord injury/disorder, multiple sclerosis, and Parkinson's disease with at least one urinary tract infection diagnosis between 2017-2018 at four medical centers.
View Article and Find Full Text PDFIntroduction: Between 1953 and 1987, over one million Veterans were exposed to contaminated water at Marine Corps Base Camp Lejeune, North Carolina. We examined the relationship between toxicant exposure and subsequent disability ratings in female veterans.
Materials And Methods: Comparisons were made between females stationed at Camp Lejeune and from Marine Corps Base Camp Pendleton, California who were not known to have been exposed to these toxicants, between 1975 and 1985, using data from the Agency for Toxic Substances and Diseases Registry and VA data.
Cannabis Cannabinoid Res
April 2024
Providers in the Department of Veterans Affairs (VA) system are caught between two opposing sets of laws regarding cannabis and cannabidiol (CBD) use by their patients. As VA is a federal agency, it must abide by federal regulations, including that the Food and Drug Administration classifies cannabis as a Schedule 1 drug and therefore cannot recommend or help Veterans obtain it. Meanwhile, 38 states have passed legislation, legalizing medical use of cannabis.
View Article and Find Full Text PDFStudy Design: Qualitative study.
Objectives: To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management.
Setting: Three Veterans Affairs (VA) medical centers.
Top Spinal Cord Inj Rehabil
March 2024
Background: Osteoporotic fractures occur in almost half of patients with a spinal cord injury (SCI) and are associated with significant morbidity and excess mortality. Paralyzed Veterans Administration (PVA) guidelines suggest that adequate calcium and vitamin D intake is important for skeletal health, however, the association of these supplements with osteoporotic fracture risk is unclear.
Objectives: To determine the association of filled prescriptions for calcium and vitamin D with fracture risk in Veterans with an SCI.
Antimicrob Steward Healthc Epidemiol
October 2023
This project surveyed Veterans' COVID-19 vaccination beliefs and status. 1,080 (30.8%) Veterans responded.
View Article and Find Full Text PDFAlthough urinary tract infections (UTIs) are common in patients with neurogenic bladder (NB), limited data exist on UTI perceptions, experiences, and beliefs in these patients. We recruited adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) at three Veterans Affairs (VA) medical centers to participate in 11 virtual focus groups. Audio transcripts were coded using a mixed approach with primary deductive codes linked to the Health Belief Model, and secondary inductive codes informed by grounded theory.
View Article and Find Full Text PDFStudy Design: Delphi Technique.
Objectives: Describe the development of a decision support tool to prevent community-acquired pressure injuries (CAPrIs) in individuals with spinal cord injury (SCI) for use in SCI clinics, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT).
Setting: Veteran Health Administration Hospital, Chicago, Illinois, USA.
Objective: Inappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been well-studied in patients with risks for complicated UTI such as neurogenic bladder (NB). Our aim was to describe ASB and UTI management in patients with NB and assess factors associated with inappropriate management.
Design: Retrospective cohort study.
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.
View Article and Find Full Text PDFJ Clin Hypertens (Greenwich)
July 2023
The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers.
View Article and Find Full Text PDFContext/objective: Our objective was to describe early participation in Whole Health programs across the Veterans Health Administration (VHA) Spinal Cord Injuries and Disorders (SCI/D) System of Care.
Design: Retrospective analysis of VHA administrative data.
Setting: The VHA SCI/D System of Care.
Importance: An increased risk of Parkinson disease (PD) has been associated with exposure to the solvent trichloroethylene (TCE), but data are limited. Millions of people in the US and worldwide are exposed to TCE in air, food, and water.
Objective: To test whether the risk of PD is higher in veterans who served at Marine Corps Base Camp Lejeune, whose water supply was contaminated with TCE and other volatile organic compounds (VOCs), compared with veterans who did not serve on that base.
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.
View Article and Find Full Text PDFObjective: The aim of the study is to characterize patient-reported signs and symptoms of urinary tract infections in patients with neurogenic bladder to inform development of an intervention to improve the accuracy of urinary tract infection diagnosis.
Design: This is a retrospective cohort study of adults with neurogenic bladder due to spinal cord injury/disorder, multiple sclerosis, and/or Parkinson disease and urinary tract infection encounters at four medical centers between 2017 and 2018. Data were collected through medical record review and analyzed using descriptive statistics and unadjusted logistic regression.
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).
Antimicrob Steward Healthc Epidemiol
December 2022
Objective: To compare clinical outcomes associated with appropriate and inappropriate management of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) among inpatients with neurogenic bladder (NB).
Design: Multicenter, retrospective cohort.
Setting: The study was conducted across 4 Veterans' Affairs hospitals.
Introduction: Some patients experience ongoing sequelae after discharge, including rehospitalization; therefore, outcomes following COVID-19 hospitalization are of continued interest. We examined readmissions within 90 days of hospital discharge for veterans hospitalized with COVID-19 during the first 10 months of the pandemic in the US.
Methods: Veterans hospitalized with COVID-19 at a Veterans Health Administration (VA) hospital from March 1, 2020, through December 31, 2020 were followed for 90 days after discharge to determine readmission rates.
Background: Through Community Care Networks (CCNs) implemented with the VA MISSION Act, VA expanded provider contracting and instituted network adequacy standards for Veterans' community care.
Objective: To determine whether early CCN implementation impacted community primary care (PC) appointment wait times overall, and by rural/urban and PC shortage area (HPSA) status.
Design: Using VA administrative data from February 2019 through February 2020 and a difference-in-differences approach, we compared wait times before and after CCN implementation for appointments scheduled by VA facilities that did (CCN appointments) and did not (comparison appointments) implement CCNs.