Examining the clinical impact of rapid multiplex polymerase chain reaction-based diagnostic testing for bloodstream infections in a national cohort of the Veterans Health Administration.

Study Objective: Bloodstream infections (BSIs) are a significant cause of mortality. Use of a rapid multiplex polymerase chain reaction-based blood culture identification panel (BCID) may improve antimicrobial utilization and clinical outcomes by shortening the time to appropriate therapy and de-escalating antibiotics among patients on overly broad-spectrum empiric therapy. The effect of BCID on clinical outcomes across varying institutional antimicrobial stewardship program (ASP) practices is unclear.

Impact of Implementation of the Core Elements of Outpatient Antibiotic Stewardship Within Veterans Health Administration Emergency Departments and Primary Care Clinics on Antibiotic Prescribing and Patient Outcomes.

Background: The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use. We report the impact of core elements implementation within Veterans Health Administration sites.

Methods: In this quasiexperimental controlled study, effects of an intervention targeting antibiotic prescription for uncomplicated acute respiratory tract infections (ARIs) were assessed.

Pharmacodynamics of daptomycin in combination with other antibiotics for the treatment of enterococcal bacteraemia.

Daptomycin is commonly prescribed in combination with other antibiotics for treatment of enterococcal bacteraemia. Whilst a free drug area under the concentration-time curve to minimum inhibitory concentration (fAUC/MIC) ratio >27.4 is associated with 30-day survival with daptomycin monotherapy, it is unknown whether receipt of other antibiotics affects this threshold.

Pharmacodynamic Analysis of Daptomycin-treated Enterococcal Bacteremia: It Is Time to Change the Breakpoint.

Background: Currently, there is debate over whether the daptomycin susceptibility breakpoint for enterococci (ie, minimum inhibitory concentration [MIC] ≤4 mg/L) is appropriate. In bacteremia, observational data support prescription of high doses (>8 mg/kg). However, pharmacodynamic targets associated with positive patient outcomes are undefined.

Implementation of an integrative medicine treatment program at a Veterans Health Administration residential mental health facility.

A 4-week interdisciplinary integrative medicine program was recently added to the core treatment offerings for veterans participating in the Mental Health Residential Rehabilitation Program at the Dwight D. Eisenhower Veterans Affairs Medical Center. The new integrative medicine program teaches veterans about using meditative practices, nutrition, creative expression, tai chi, hatha yoga, sensory and breathing techniques, and lifestyle changes to enhance well-being.

Effect of Continuous and Sequential Therapy among Veterans Receiving Daptomycin or Linezolid for Vancomycin-Resistant Enterococcus faecium Bacteremia.

Vancomycin-resistant bloodstream infections (VREF-BSI) cause significant mortality, highlighting the need to optimize their treatment. We compared the effectiveness and safety of daptomycin (DAP) and linezolid (LZD) as continuous or sequential therapy for VREF-BSI in a national, retrospective, propensity score (PS)-matched cohort study of hospitalized Veterans Affairs patients (2004 to 2014). We compared clinical outcomes and adverse events among patients treated with continuous LZD, continuous DAP, or sequential LZD followed by DAP (LZD-to-DAP).

Comparative Effectiveness and Safety of Standard-, Medium-, and High-Dose Daptomycin Strategies for the Treatment of Vancomycin-Resistant Enterococcal Bacteremia Among Veterans Affairs Patients.

Background: Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSIs) are associated with significant mortality. Daptomycin exhibits concentration-dependent activity vs VRE in vitro, yet the clinical impact of higher-dose strategies remains unclear.

Methods: We performed a national retrospective cohort study of hospitalized Veterans Affairs patients treated with standard-dose (6 mg/kg total body weight), medium-dose (8 mg/kg total body weight), or high-dose (≥10 mg/kg total body weight) daptomycin for VRE-BSI.

Clinical epidemiology of vancomycin-resistant and bloodstream infections.

This study aimed to evaluate the clinical outcomes of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) caused by or . Variables associated with treatment failure were determined and treatment options were compared. This was a national retrospective study of hospitalised Veterans Affairs patients with non-, non- VRE BSI.

Vitamin Supplementation in the Elderly.

Vitamin supplementation is fairly common among the elderly. Supplements are often used to prevent disease and improve health. In the United States, the use of dietary supplements has continued to increase over the last 30 years, and more than half of adults report using one or more dietary supplements.

Comparison of the Effectiveness and Safety of Linezolid and Daptomycin in Vancomycin-Resistant Enterococcal Bloodstream Infection: A National Cohort Study of Veterans Affairs Patients.

Background: Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSIs) are becoming increasingly common. Linezolid and daptomycin are the primary treatment options for VRE-BSI, but optimal treatment is unclear.

Methods: This was a national retrospective cohort study comparing linezolid and daptomycin for the treatment of VRE-BSI among Veterans Affairs Medical Center patients admitted during 2004-2013.

Tigecycline for the Treatment of Severe and Severe Complicated Clostridium difficile Infection.

Introduction: Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhea. Metronidazole and vancomycin are the primary treatment options for CDI, but increasing rates of antimicrobial resistance and severe, refractory disease have prompted the need for alternative agents. Tigecycline has previously demonstrated favorable in vitro activity against C.

Age effects on Wechsler Adult Intelligence Scale-III subtests.

This investigation extended work on the Wechsler Adult Intelligence Scaled-Revised (WAIS-R) to the WAIS-III by determining how allotments of scaled-score points change with age, and to evaluate WAIS-III performance in terms of the Horn-Cattell constructs of crystallized and fluid intelligence. The age norms for the 14 individual WAIS-III subtests indicate that additional scaled-score points are awarded primarily to the Letter-Number Sequencing subtest of the Verbal Scale and to the seven Performance Scale subtests at ages 45 to 89 years for the same performance as individuals in the 20- to 34-year-old reference group. Subtests that measure speed of information processing showed more of a decline than subtests that measure verbal processing.

Accuracy of the seven subtest WAIS-R short form in chronic schizophrenia.

The accuracy of the WAIS-R seven subtest short form (Ward, L.C., 1990.

Development and preliminary validation of a Satz-Mogel short form of the WAIS-III in a sample of persons with substance abuse disorders.

We developed a Satz-Mogel short form of the WAIS-III and evaluated its accuracy for predicting IQs of 50 men with substance abuse disorders. Means for age, education, and Full Scale IQ were 44.20 years (SD = 7.

Research contributions of counseling psychologists to neuropsychology.

Research productivity of counseling psychologists with credentials in clinical neuropsychology were examined. Eighteen were ABPP/ABCN Diplomates. Division 40 Fellows, or both.

Utility of the seven subtest WAIS-R short form in a female sample with brain damage.

We examined the accuracy of the WAIS-R seven subtest short form (Ward, 1990) for predicting IQs of 130 females with brain damage or dysfunction. Means for age, education, and FSIQ were 44.37 years (SD = 18.

Base rate of "10 to 11" clocks among patients referred for neuropsychological evaluation.

Of 655 neuropsychological referrals who were asked to draw a clock and set the hands at "10 after 11," 9% set the hands at "10 to 11." This low base rate of occurrence suggests the error was not highly sensitive to neurological impairment or diagnostically specific.

Ruptured pancreaticoduodenal arterial aneurysms: diagnosis and treatment by angiographic intervention.

This article describes a 54-year-old patient who presented with a long history of epigastric pain. Laboratory values revealed a decreased red blood cell count, decreased hemoglobin level, and positive stool hemoccult test. A computed tomography scan of the abdomen revealed intra-abdominal and retroperitoneal hematomas.