Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility.

Background: Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs.

Methods: A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods.

Insomnia Symptoms and Environmental Disruptors: A Preliminary Evaluation of Veterans in a Subacute Rehabilitation.

Objectives: Evaluate insomnia symptoms and environmental disruptors at admission and discharge in a subacute rehabilitation care setting.

Methods: Veterans (age ≥50) admitted to a Veterans Health Administration (VA) Hospital subacute rehabilitation between March and August 2022 completed baseline ( = 46) and follow up ( = 33) assessments with the Insomnia Severity Index (ISI), Sleep Need Questionnaire (SNQ), Epworth Sleepiness Scale (ESS), and an assessment of environmental sleep disruptors. Veterans were offered sleep resources after admission evaluations and outpatient referrals after discharge evaluations.

Coordinated-Transitional Care (C-TraC) for Veterans from Subacute Rehabilitation to Home.

Objectives: To adapt a successful acute care transitional model to meet the needs of veterans transitioning from post-acute care to home.

Design: Quality improvement intervention.

Setting And Participants: Veterans discharged from a subacute care unit in the VA Boston Healthcare System's skilled nursing facility.

An innovative rehabilitation program for the veterans affairs post-acute skilled nursing setting: Preliminary results.

Background: Skilled nursing rehabilitative care plays a critical role in older adults' functional recovery impacting post-discharge outcomes. Variations across post-acute rehabilitative care services and patient outcomes indicate a need to improve rehabilitative care in this setting. We adapted a successful outpatient care program (Live Long Walk Strong-LLWS) to address this need in post-acute care settings within the Veterans Health Administration.

Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility.

Background: Unintentional medication discrepancies due to inadequate medication reconciliation pose a threat to patient safety. Skilled nursing facilities (SNFs) are an important care setting where patients are vulnerable to unintentional medication discrepancies due to increased medical complexity and care transitions. This study describes a quality improvement (QI) approach to improve medication reconciliation in an SNF setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2).

Addressing the Shortage of Physician Assistants in Medicine Clerkship Sites.

Addressing the shortage of clerkship sites, the VA Boston Healthcare System developed a physician assistant training program in a postacute health care setting.

My life, my story: Teaching patient centered care competencies for older adults through life story work.

We implemented "My Life, My Story" as an educational activity for enhancing patient-centered care (PCC) competencies across health professions trainees. Four hundred and eighty-two stories were completed for patients (M age = 72.5, SD = 12.

Improved Transitional Care Through an Innovative Hospitalist Model: Expanding Clinician Practice From Acute to Subacute Care.

Hospitalist physician rotations between acute inpatient hospitals and subacute care facilities with dedicated time in each environment may foster quality improvement and educational opportunities.

Improving Access to Care by Admission Process Redesign in a Veterans Affairs Skilled Nursing Facility.

Background: Inefficient and inadequate nursing home screening processes can delay care transitions from hospitals to post-acute care facilities and result in inappropriate and delayed transfers. The increased volume of admission requests and need for efficient and effective transfers between care settings converged to make the Community Living Center (CLC; skilled nursing facility in the Department of Veterans Affairs) admission screening process an organizational priority for improvement. A quality improvement (QI) project was conducted to develop a new process for a 112-bed CLC and improve efficiency and access to care.

empyema in a patient with metastatic squamous cell carcinoma of the lung.

We report a rare case of (CP) empyema in a patient with metastatic squamous cell cancer of the lung. Clostridial empyemas are rare and clinically variable with some reports noting consequent necrotizing infections and septic shock and others noting quick resolution with source control and antibiotic treatment. This is the first case report to our knowledge to report a CP empyema in a patient with lung malignancy.

Respiratory Tract Infection Clinical Trials from 2007 to 2012. A Systematic Review of ClinicalTrials.gov.

Rationale: Respiratory tract infections are highly prevalent and variable, and confer considerable morbidity and mortality. There is a growing need for new treatments for such infections, particularly in the setting of worsening antibacterial resistance.

Objectives: We analyzed data from ClinicalTrials.

Monitoring quality control: can we get better data?

Quality control is important in many fields, especially industrial production. Major research has been developed with regard to industrial quality control to ensure reliable and consistent products. We adapt and develop methodology in quality control to monitor data collection in epidemiologic studies.

Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection.

The receiver operating characteristic (ROC) curve is used to evaluate a biomarker's ability for classifying disease status. The Youden Index (J), the maximum potential effectiveness of a biomarker, is a common summary measure of the ROC curve. In biomarker development, levels may be unquantifiable below a limit of detection (LOD) and missing from the overall dataset.

Evidence of absence or absence of evidence? A reanalysis of the effects of low-dose aspirin in in vitro fertilization.

Objective: To assess the conflicting evidence whether low-dose aspirin is beneficial in IVF and to evaluate the meta-analysis performed by Gelbaya et al. and reported in March 2007 in Human Reproduction Update, in which they found no effects of low-dose aspirin and recommended discontinuing its use in IVF. We present a reanalysis of the effects of low-dose aspirin in IVF and raise methodological questions regarding the analysis by Gelbaya et al.