Improving skin screening capabilities for Veterans with spinal cord injuries.

Context: Clinical Practice Guidelines from the Consortium for Spinal Cord Injury (SCI) Medicine recommend daily self-screening of at-risk skin surfaces, but many Veterans with SCI describe challenges using the standard issue long-handled self-inspection mirror (LSIM).

Objective: The objective of this project was to compare the LSIM to a recently developed camera-based self-inspection system (CSIS). User feedback guided iterative engineering to improve and develop the new technology in preparation for transfer to industry.

Implementation and clinical impact of an interdisciplinary tool to promote skin integrity after flap surgery in Veterans with spinal cord injury.

Context/objective: Pressure injury (PrI) recurrence is common among persons with spinal cord injury and disorders (SCI/D) who undergo reconstructive flap surgery for pelvic stage 4 PrI (S4PrI). This paper describes the development and implementation of the Minneapolis Spinal Cord Optimization, Rehabilitation and Empowerment (SCORE), a preoperative interdisciplinary tool for risk assessment and mitigation, and reports its effect on the one-year flap failure rate (significant breakdown).

Design: Retrospective review.

Women Veterans' Stroke Risk Factors: Identified Prevention Methods and Knowledge Gaps.

Introduction: Stroke is a significant health burden for veterans and the fifth leading cause of death for women. Compared to civilian women, women veterans have significant multimorbid physical and mental health conditions contributing to their stroke risk. This scoping review aimed to synthesize evidence on the stroke risk factors specific to U.

Influencers of participation in social roles and activities among women veterans with lower extremity amputations: an exploratory qualitative study.

Purpose: Women military Veterans with lower extremity amputations are a growing subpopulation of Veterans. There is a paucity of exploration into factors influencing participation in meaningful social roles and activities within this population. Thus, the purpose of this qualitative study was to evaluate influencers of participation among women Veterans with lower limb amputations.

Clinician perspectives on postamputation pain assessment and rehabilitation interventions.

Objective: The purpose of this study was to explore self-reported Veterans Affairs (VA) amputation clinician perspectives and clinical practices regarding the measurement and treatment for amputation-related pain.

Study Design: Cross-sectional survey with 73 VA rehabilitation clinicians within the VA Health Care System.

Results: The most frequent clinical backgrounds of respondents included physical therapists (36%), prosthetists (32%), and physical medicine and rehabilitation specialist (21%).

Veteran Perspectives on Phantom Limb Pain and Non-Drug Interventions.

Background: Phantom limb pain (PLP) commonly occurs post-amputation and can negatively affect the daily functioning of persons with amputation. Best practices for medication and non-drug management remain unclear.

Objective: To better understand the PLP experience and patients' familiarity with treatments, phone interviews were conducted at the Minneapolis Veterans Affairs Regional Amputation Center in Veterans with amputations.

Impact of Antihypertensive Drug Class on Outcomes in SPRINT.

Background: The primary objective of this analysis is to assess if greater exposure to any major antihypertensive drug class was associated with reduced primary composite outcome events in SPRINT (Systolic Blood Pressure Intervention Trial).

Methods: This is a secondary analysis of the SPRINT trial evaluating whether longitudinal, time varying exposure to any major antihypertensive drug class had any impact on primary outcome events, after adjusting for effects of randomization arm, time varying achieved systolic blood pressure, other drug class exposure, and baseline characteristics.

Results: Nine thousand two hundred fifty-two participants were included.

Supine arm cycling during the post-flap recovery period for persons with spinal cord injuries: The multi-purpose arm cycle ergometer (M-PACE) safety and pilot testing.

Objective: To describe how using a supine arm cycle ergometer can safely reduce deconditioning experienced by patients with spinal cord injury or disorder (SCI/D) during their four to six weeks of complete bed rest after surgery to close a stage 4 pressure injury.

Design: This pilot project used a newly designed arm cycle ergometer (known as the M-PACE) that extends over the bed, allowing a patient to lie completely supine while exercising.

Setting: The M-PACE was designed and built at the Minneapolis Veterans Affairs Health Care System (MVAHCS) and pilot tested at the MVAHCS SCI/D Center.

User-centered design and development of a trunk control device for persons with spinal cord injury: A pilot study.

Context/objective: There are no wheelchair products designed to allow users to dynamically control trunk posture to both significantly improve functional reach and provide pressure relief during forward lean. This pilot study sought to (1) gather stakeholder desires regarding necessary features for a trunk control system and (2) subsequently develop and pilot test a first-generation trunk control prototype.

Design: Multi-staged mixed methods study design.

Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries.

Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction wit h AW-Shift©.

Impact of Intensive Blood Pressure Therapy on Concern about Falling: Longitudinal Results from the Systolic Blood Pressure Intervention Trial (SPRINT).

Objectives: Concern about falling is common among older hypertension patients and could impact decisions to intensify blood pressure therapy. Our aim was to determine whether intensive therapy targeting a systolic blood pressure (SBP) of 120 mm Hg is associated with greater changes in concern about falling when compared with standard therapy targeting an SBP of 140 mm Hg.

Design: Subsample analysis of participants randomized to either intensive or standard therapy in the Systolic Blood Pressure Intervention Trial (SPRINT).

Development of a comprehensive mobile assessment of pressure (CMAP) system for pressure injury prevention for veterans with spinal cord injury.

: This paper reports the iterative redesign, feasibility and usability of the Comprehensive Mobile Assessment of Pressure (CMAP) system's mobile app used by Veterans with SCI.: This three-year, multi-staged study used a mixed-methods approach.: Minneapolis VA Health Care System, Minneapolis, Minnesota.

Microclimate evaluation of strap-based wheelchair seating systems for persons with spinal cord injury: A pilot study.

Study Purpose: The purpose of this pilot study was to assess microclimate characteristics of two versions of a strap-based wheelchair seating system (perforated and solid straps) and to conduct preliminary microclimate comparisons of subjects' current wheelchair seating systems.

Materials And Methods: In this pilot study, the microclimate properties of two variations (solid and perforated) of a strap-based seating system were compared with two commonly used seating systems. Six subjects sat on three different seating systems each for 100-min test periods, while temperature and relative humidity were measured with a single sensor adjacent to the skin-seat interface.

Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes.

Background: The previously published results of the Systolic Blood Pressure Intervention Trial showed that among participants with hypertension and an increased cardiovascular risk, but without diabetes, the rates of cardiovascular events were lower among those who were assigned to a target systolic blood pressure of less than 120 mm Hg (intensive treatment) than among those who were assigned to a target of less than 140 mm Hg (standard treatment). Whether such intensive treatment affected patient-reported outcomes was uncertain; those results from the trial are reported here.

Methods: We randomly assigned 9361 participants with hypertension to a systolic blood-pressure target of less than 120 mm Hg or a target of less than 140 mm Hg.

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline.

Orthostatic changes in systolic blood pressure (SBP) impact cardiovascular outcomes. In this study, we aimed to determine the pattern of orthostatic systolic pressure changes in participants enrolled in the SBP Intervention Trial (SPRINT) at their baseline visit before randomization and sought to understand clinical factors predictive of these changes. Of the 9323 participants enrolled in SPRINT, 8662 had complete data for these analyses.

A Multisite Quality Improvement Project to Standardize the Assessment of Pressure Ulcer Healing in Veterans with Spinal Cord Injuries/Disorders.

Objective: The objective was to implement the evidence-based Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in 23 Spinal Cord Injury/Disorders Centers (SCI/D) in the Veterans Health Administration (VHA).

Setting: A collaborative was held in Minnesota that was attended by key personnel from SCI/D Centers in the VHA.

Methods: This initiative was based on a 3-year longitudinal study that established the validity and reliability of a novel pressure ulcer monitoring tool for persons with spinal cord impairment.

Recruitment strategies and challenges in a large intervention trial: Systolic Blood Pressure Intervention Trial.

Background: The Systolic Blood Pressure Intervention Trial is a multicenter, randomized clinical trial of 9361 participants with hypertension who are ≥50 years old. The trial is designed to evaluate the effect of intensive systolic blood pressure control (systolic blood pressure goal <120 mm Hg) compared to standard control (systolic blood pressure goal <140 mm Hg) on cardiovascular events using commonly prescribed antihypertensive medications and lifestyle modification.

Objective: To describe the recruitment strategies and lessons learned during recruitment of the Systolic Blood Pressure Intervention Trial cohort and five targeted participant subgroups: pre-existing cardiovascular disease, pre-existing chronic kidney disease, age ≥75 years, women, and minorities.

Spinal Cord Injury survey to determine pressure ulcer vulnerability in the outpatient population.

Pressure ulcers are one of the most common causes of morbidity, mortality and rehospitalization for those living with Spinal Cord Injury (SCI). Literature examining risk and recurrence of pressure ulcers (PrUs) has primarily focused on the nursing home elderly who do not have SCI. More than 200 factors that increase PrU risk have been identified.

Characteristics of project management at institutions sponsoring National Library of Medicine MedlinePlus Go Local.

Objectives: Through interviews with the National Library of Medicine's MedlinePlus Go Local collaborators, an evaluation team sought to identify process characteristics that are critical for long-term sustainability of Go Local projects and to describe the impact that Go Local projects have on sponsoring institutions.

Methods: Go Local project coordinators (n = 44) at 31 sponsor institutions participated in semi-structured interviews about their experiences developing and maintaining Go Local sites. Interviews were summarized, checked for accuracy by the participating librarians, and analyzed using a general inductive methodology.

Connected care: reducing errors through automated vital signs data upload.

Vital signs are a fundamental component of patient care. Omitted or inaccurately transcribed vital sign data could result in inappropriate, delayed, or missed treatment. A previous baseline study determined that error rates for vital signs captured on plain paper then entered into a paper chart or EMR were 10% and 4.

Automated clinical documentation: does it allow nurses more time for patient care?

When a west central Florida hospital prepared to move to an electronic health record with a clinical documentation system, the nursing staff and administration were concerned about the effects that the technology change would have on nursing work behavior. Specifically, would the move toward automation increase the time at the bedside, decrease the time nurses spent on documentation, and decrease time spent on administrative tasks? A time-in-motion study was conducted to specifically measure six categories of nurse work behavior on a progressive cardiac unit. The nurses were observed by data collectors prior to the implementation of the electronic health record and then again a year after the implementation.