"It's Traumatic for All of Us": A Qualitative Analysis of Providers Caring for Seriously Ill Veterans With Surgical Conditions.

Objective: We aimed to characterize sources of moral distress among providers in the context of surgery.

Background: Moral distress is defined as psychological unease generated when professionals identify an ethically correct action to take but are constrained in their ability to take that action. While moral distress has been reported among healthcare providers, the perspectives of providers working in surgery specifically are not often explored and reported.

"You have to hold their hand": experiences of providers integrating virtual care and communication methods while caring for ICU patients during the COVID-19 pandemic.

Background: The rapid expansion of synchronous telephone and video virtual care options allowed the Veterans Health Administration (VHA) to adapt to the coronavirus disease 2019 (COVID-19) pandemic and provided a unique opportunity to assess the potential for integration and utility of virtual care in VHA systems. The objective of this study was to highlight the perspectives of VHA providers caring for intensive care unit (ICU) patients during the COVID-19 pandemic and their views on the use of virtual care and communication for palliative and end-of-life patients.

Methods: Forty-eight semi-structured qualitative interviews were conducted with providers between April 2021 and March 2022 and were analyzed using steps informed by thematic content analysis.

Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project.

Purpose: The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients.

Participants And Setting: Health care staff (n = 112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n = 24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n = 9) between January and March 2021.

American College of Medical Genetics and Genomics ACT Sheets Are a Vital Resource for State Newborn Screening Programs.

The American College of Medical Genetics and Genomics (ACMG) and the National Coordinating Center for the Regional Genetics Networks (NCC)-developed ACT sheets are a vital resource for state newborn screening (NBS) programs. They allow NBS programs to be able to provide up-to-date, just-in-time disorder information to primary care providers (PCPs). Their continued availability is necessary to ensure that all babies identified by newborn screening receive appropriate evaluation and care.

"Do No Harm?" Moral Distress Among Medical Students During the Surgical Clerkship.

Objectives: Moral distress, reported among healthcare workers across a variety of settings, is associated with negative mental health consequences, burnout, and intention to leave a position. The scant literature exploring medical students' moral distress does not specifically examine moral distress during the surgical clerkship nor does it characterize the type of moral distress experienced by medical students. Thus, we aimed to explore and characterize medical students' moral distress during the surgical clerkship.

Identifying Areas of High Vulnerability for Rural Veteran Food Insecurity.

Introduction/objectives: Americans, including veterans, living in rural areas experience higher rates of food insecurity than the general population in the United States, but rural veteran food insecurity remains an understudied subject. Due to a lack of data on the subject, this project aimed to use geographic information systems (GIS) mapping of proxy variables for rural veteran food insecurity in order to identify areas of high vulnerability where future research could be targeted.

Methods: Key factors which may indicate vulnerability to rural veteran food insecurity were identified in a review of the literature.

Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey - a qualitative analysis.

Background: End-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS).

Methods: We examined data from the BFS open-text responses to explore insights into surgical patient's end-of-life care.

Alcohol perceptions and driving decisions among adolescents: Exploring the role of peer and parental influences in Virginia.

Objective: This study aims to explore the role of peer and parental influences on adolescent driving behaviors, particularly concerning distracted and alcohol-impaired driving, in light of the significant number of road accidents and fatalities involving young drivers.

Methods: A cross-sectional study was conducted using data from the IMPACT program. Adolescents aged 14 to 19 in the Richmond area were recruited from local high schools through convenience sampling.

Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation.

Background: Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.

Methods: Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries.

Aims: Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate.

Improving HPV Vaccination Rates: A Comprehensive Evaluation of a Clinician-Centered Educational Initiative in a Wisconsin Health Care System.

Introduction: Human papillomavirus (HPV) infection poses significant public health concerns due to its prevalence and association with various cancers. This study assesses a 2014 quality improvement initiative in Wisconsin's largest health care system. The intervention aimed to improve HPV vaccine initiation and completion among eligible patients and to reduce the gap in vaccination rates between males and females.

Understanding patient experiences to improve care for females groin hernia.

Background: Thousands of females undergo inguinal hernia repair annually, yet females have been excluded from prior clinical trials evaluating inguinal hernia repairs. Research shows females face worse outcomes after hernia repair compared to males, including higher recurrence rates, increased chronic pain, and limited data to guide treatment. Prospective studies focused on optimizing outcomes for females are critically needed.

The Role of Informal Social Support for Patients Undergoing Bariatric Surgery.

Background: Bariatric surgery is underutilized as a treatment for metabolic disease and its associated comorbidities. While social support is known to play a crucial role in outcomes following bariatric surgery, little is known about the role of social support prior to surgery, which may impact preparedness for and willingness to undergo surgery. The study's objective was to examine the role of informal social support prior to bariatric surgery, the types of support received, and patient attitudes toward different demonstrations of support.

Memory Loss and Missteps: Investigating Fall Risks in Alzheimer's and Dementia Patients.

Background: Degenerative diseases such as Alzheimer's disease and dementia are significant health concerns among older adults in the United States, contributing substantially to the high incidence of falls in this population. This study aims to investigate the incidence and prevalence of falls among older adults diagnosed with Alzheimer's disease and dementia and explore the association between these conditions and the occurrence of traumatic brain injuries (TBIs).

Methods: A retrospective cohort study was conducted using data from 17,000 older adults aged 65 and above, arrived at the hospital with fall related injuries, obtained from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) between January 1, 2019, and December 31, 2023.

"It's Really About Those Social Determinants of Health that Drive It": Addressing Food Insecurity in Rural Veterans.

Background: The Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans.

Methods: Qualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10).

Crisis Management by Obstetrics and Gynecologist Hospitalists: Lessons Learned in a Pandemic.

We discuss lessons learned from the COVID-19 pandemic through an obstetrics and gynecology (OB/GYN) hospitalist lens, with a focus on clinical care considerations, workforce changes, communication and collaboration, and provider wellness. We end with a discussion on the role of OB/GYN hospitalists as leaders. Our goal is to share what worked well for hospital systems and OB/GYN hospitalist teams during COVID-19, along with recommendations to consider for future national emergencies.

"Just Food doesn't Do It": Understanding Food Insecurity Among Rural Veterans in the United States.

Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability.

The Impact of Demographics and Comorbidities on Fall Incidence and Prevalence in Older Adults.

Introduction: Falls among older adults are more than mere accidents; they are a silent epidemic, profoundly impacting the health and well-being of millions of older adults worldwide. This study examines the incidence and prevalence of falls among individuals aged 65 and above, focusing on the influence of demographic factors and comorbid conditions such as hypertension, diabetes mellitus, cancer, and obesity.

Methods: A retrospective cohort study was conducted using data from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) from 2019 to 2023.

Barriers to Participation in a Structured Quality Improvement Initiative to Reduce Avoidable Emergency Department Visits-A Qualitative Study.

Introduction: Barriers to quality improvement (QI) initiatives in multi-institutional hospital settings are understudied. Here we describe a qualitative investigation of factors negatively affecting a QI initiative focused on reducing avoidable emergency department (ED) visits after bariatric surgery across 17 hospitals. Our goal was to explore participant perspectives and identify themes describing why the program was not effectively implemented or why the program may have been ineffective when correctly implemented.

Patient adherence to an oral rehydration solution intervention to prevent dehydration following ileostomy creation: A qualitative study.

Background: Patients undergoing surgery for ileostomy creation frequently experience postoperative dehydration and subsequent renal injury. The use of oral rehydration solutions (ORS) has been shown to prevent dehydration, but compliance may be variable.

Methods: Semi-structured qualitative interviews were conducted with 17 patients who received a postoperative hydration kit and dehydration education to assess barriers and facilitators to compliance with ORS kit instructions.

The obstetrical emergency department: need, rationale, and guide to implementation.

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee.

Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys.

Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women's risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in LMICs over the last decade. Using cross-sectional data from 49 Demographic and Health Surveys, we applied competing risks estimation to calculate monthly probabilities of contraceptive resumption and pregnancy over a 12-month period among pooled, regional, and country-specific samples of women who discontinued contraception for method-related reasons (corresponding to 174,726 episodes of discontinuation).

Original Research: What Health Care Staff Who Experienced Assisted Patient Falls Can Teach Us: Implications for Fall and Fall Injury Risk.

Purpose: This quality improvement project had three aims: to identify common assisted falls scenarios, describe staff members' experiences with and risk perceptions of such falls, and explore factors that influenced their perceptions. The overarching goal was to gain useful insight for the development of assisted fall-related strategies and policies.

Methods: In the fall of 2020, 16 staff members from 13 health care facilities were purposively recruited and interviewed.

The Relationship Between Contraceptive Method Use and Return of Fecundity Among Women Attempting Pregnancy in Low- and Middle-Income Countries.

One of the most common barriers to using effective family planning methods is the belief that hormonal contraceptives and contraceptive devices have adverse effects on future fertility. Recent evidence from high-income settings suggests that some hormonal contraceptive methods are associated with delays in return of fecundity, yet it is unclear if these findings generalize to low- and middle-income populations, especially in regions where the injectable is widely used and pressure to bear children is significant. Using reproductive calendar data pooled across 47 Demographic and Health Surveys, we find that the unadjusted 12-month probability of pregnancy for women attempting pregnancy after discontinuing traditional methods, condoms, the pill, and the IUD ranged from 86% to 91%.