Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration.

Background: The STOPP study (Surgical Treatment Outcomes for Patients with Psychiatric Disorders) analyzed variation in rates and types of major surgery by serious mental illness status among patients treated in the Veterans Health Administration (VA). VA patients are veterans of United States military service who qualify for federal care by reason of disability, special service experiences, or poverty.

Methods: STOPP conducted a secondary data analysis of medical record extracts for seven million VA patients treated Oct 2005-Sep 2009.

Posttransplantation Outcomes in Veterans With Serious Mental Illness.

Background: Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI.

Methods: This study analyzed health services data to evaluate posttransplantation 3-year survival by SMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA).

Mortality after cardiac or vascular operations by preexisting serious mental illness status in the Veterans Health Administration.

Objective: To estimate 1-year mortality risk associated with preoperative serious mental illness (SMI) as defined by the Veterans Health Administration (schizophrenia, bipolar disorder, posttraumatic stress disorder [PTSD], major depression) following nonambulatory cardiac or vascular surgical procedures compared to patients without SMI. Cardiac/vascular operations were selected because patients with SMI are known to be at elevated risk of cardiovascular disease.

Method: Retrospective analysis of system-wide data from electronic medical records of patients undergoing nonambulatory surgery (inpatient or day-of-surgery admission) October 2005-September 2009 with 1-year follow-up (N=55,864; 99% male; <30 days of postoperative hospitalization).

Femoral neck stress fracture in Air Force basic trainees.

Stress fractures are a common overuse problem among military trainees resulting in preventable morbidity, prolonged training, and long-term disability following military service. Femoral neck stress fractures (FNSFs) account for 2% of all stress fractures but result in disproportionate burden in terms of cost and convalescence. The purpose of this study was to describe and investigate FNSF in U.

Definition, incidence, risk factors, and prevention of paralytic ileus following radical cystectomy: a systematic review.

Context: Postoperative paralytic ileus (POI) has profound clinical consequences because it represents a substantial burden on both patients and health care resources.

Objective: To determine the knowledge base regarding POI in the radical cystectomy (RC) population with an emphasis on preventive measures and risk factors.

Evidence Acquisition: A systematic literature search of Medline (1966 to February 2011) and a study review were conducted.

Ethnicity and Race Variations in Receipt of Surgery among Veterans with and without Depression.

To examine equity in one aspect of care provision in the Veterans Health Administration, this study analyzed factors associated with receipt of coronary artery bypass graft (CABG), vascular, hip/knee, or digestive system surgeries during FY2006-2009. A random sample of patients (N = 317, 072) included 9% with depression, 17% African-American patients, 5% Hispanics, and 5% women. In the four-year followup, 18,334 patients (6%) experienced surgery: 3,109 hip/knee, 3,755 digestive, 1,899 CABG, and 11,330 vascular operations.

Transition from military to VHA care: psychiatric health services for Iraq/Afghanistan combat-wounded.

Objective: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF.

Prediabetes assessment and follow-up in older veterans with schizophrenia.

Objectives: Assess glycemic monitoring and follow-up.

Design: Retrospective study using administrative data (October 2001-September 2005).

Setting: Veterans Health Administration.

The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure.

Background: Despite applications of models of care and organizational or system-level interventions to improve patient outcomes for chronic disease, consistent improvements have not been achieved. This may reflect a mismatch between the interventions and the nature of the settings in which they are attempted. The application of complex adaptive systems (CAS) framework to understand clinical systems and inform efforts to improve them may lead to more successful interventions.

Variations in pharmacology of beta-blockers may contribute to heterogeneous results in trials of perioperative beta-blockade.

Background: Randomized controlled trials and meta-analyses provide conflicting guidance on the role of beta-adrenergic receptor blockers (beta-blockers) in reducing perioperative complications. We hypothesize that variability in trial results may be due in part to heterogeneous properties of beta-blockers. First, we propose that the extent of beta-blocker metabolism by cytochrome P-450 and the time available to titrate the dosage before surgery (titration time) may interact; dependence on P-450 may be most harmful when titration time is short.

Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization.

Background: Patients with schizophrenia have difficulty managing their medical healthcare needs, possibly resulting in delayed treatment and poor outcomes. We analyzed whether patients reduced primary care use over time, differentially by diagnosis with schizophrenia, diabetes, or both schizophrenia and diabetes. We also assessed whether such patterns of primary care use were a significant predictor of mortality over a 4-year period.

Postoperative complications in the seriously mentally ill: a systematic review of the literature.

Objective: To determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness.

Background: Despite a burgeoning literature during the last 20 years regarding perioperative risk management, little is known about intraoperative and postoperative complications among patients with schizophrenia and other serious mental illnesses.

Methods: A systematic literature search of Medline (1966-August 2007) and review of studies was conducted.

Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model.

Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure is truly less invasive is not known. We compared perioperative cardiopulmonary parameters during NOTES with standard laparoscopy.

Cancer rates, medical comorbidities, and treatment modalities in the oldest patients.

Cancer disproportionately afflicts older patients, with 56% of incident diagnoses and 71% of deaths occurring in this population. Yet little is known about the "oldest of the old", oncology patients underrepresented in clinical trials. We examined elderly veterans diagnosed with lung, colorectal, prostate or head-neck cancer in 2005 (n=194,797), analyses comparing treatment receipt by age group, 70-84 versus 85-115.

Postoperative pulmonary infections.

Introduction: Postoperative pulmonary infections are associated with cough, phlegm, shortness of breath, chest pain, temperature above 38 degrees C, and pulse rate above 100 a minute. Up to half of people may have asymptomatic chest signs after surgery, and up to a quarter develop symptomatic disease. The main risk factor is the type of surgery, with higher risks associated with surgery to the chest, abdomen, and head and neck compared with other operations.

HIV infection increases the risk of heparin-induced thrombocytopenia.

The incidence of heparin-induced thrombocytopenia in human immunodeficiency virus (HIV)-infected inpatients was compared with that in a control group that was not known to be infected with HIV in a retrospective cohort study. HIV-infected patients receiving heparin therapy, especially unfractionated heparin therapy, were at increased risk of developing heparin-induced thrombocytopenia, compared with HIV-uninfected patients.

Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes.

Background: Despite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems.

Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.

Background: Postoperative pulmonary complications are as frequent and clinically important as cardiac complications in terms of morbidity, mortality, and length of stay. However, there has been much less research and no previous systematic reviews of the evidence of interventions to prevent pulmonary complications.

Purpose: To systematically review the literature on interventions to prevent postoperative pulmonary complications after noncardiothoracic surgery.

Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.

Background: The importance of clinical risk factors for postoperative pulmonary complications and the value of preoperative testing to stratify risk are the subject of debate.

Purpose: To systematically review the literature on preoperative pulmonary risk stratification before noncardiothoracic surgery.

Data Sources: MEDLINE search from 1 January 1980 through 30 June 2005 and hand search of the bibliographies of retrieved articles.

Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians.

Postoperative pulmonary complications play an important role in the risk for patients undergoing noncardiothoracic surgery. Postoperative pulmonary complications are as prevalent as cardiac complications and contribute similarly to morbidity, mortality, and length of stay. Pulmonary complications may even be more likely than cardiac complications to predict long-term mortality after surgery.

Making medical research clinically friendly: a communication-based conceptual framework.

Context: It often takes a long time before the results of medical research are actually used by health care practitioners in day-to-day clinical settings. This problem, referred to as "the evidence-to-practice gap", has significant implications for patient health care. Practitioners have difficulty keeping up with the latest information in part because it is reported in hundreds of journals that may not be easily accessed and understood.

Functional independence after major abdominal surgery in the elderly.

Background: Elders undergo approximately 40% of more than 1 million major abdominal operations annually. Yet evidence about recovery to preoperative levels of functional independence is limited. This study details course and predictors of functional recovery after elective major abdominal operations in the elderly.