Implementation of peer specialists in Veterans Health Administration primary care: Improving program fidelity through enhanced preimplementation support.

Peer specialists (PS) in the Veterans Health Administration are veteran employees with lived mental health experience supporting others in recovery. While PS worked in traditional mental health settings for many years and demonstrated benefits to veteran engagement and satisfaction with health care, little is known about the best strategies to support implementation in novel, complex settings like primary care (PC). Implementation facilitation, which combined external facilitation plus national resources, was chosen to promote uptake when the VA MISSION Act of 2018 required the Veterans Health Administration to implement PS into PC.

Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans.

Background: Advance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a "Next Step" to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs.

Training clinical professionals to deliver a patient centered intervention in healthcare settings.

Within the healthcare settings of the United States Department of Veterans Affairs (VA), one patient-centered intervention, Advance Care Planning via Group Visits (ACP-GV), engages veterans and those they trust in advance care planning (ACP) by facilitating a discussion that encourages participants to plan for future healthcare needs. ACP-GV is a one-hour, single session group intervention facilitated by a trained clinical professional (e.g.

Myxaoside A, a new triterpenoid saponin from L. (Boraginaceae).

The phytochemical study of L. led to the isolation, through chromatographic techniques, of a new triterpenoid saponin, 3--[--rhamnopyranosyl-(1→3)-(6--acetyl---glucopyranosyl)]-22-hydroxyolean-12-ene () namely Myxaoside A, together with three known compounds, Soyasaponine I (), oleanolic acid (), and 3--acetyl-oleanolic acid (). All structures were established, based on 1 & 2D-NMR spectroscopic analysis and comparison with previous published reports.