Safety Climate Associated With Adverse Events in Nursing Homes: A National VA Study.

Objectives: Adverse events in nursing homes are leading causes of morbidity and mortality, prompting facilities to investigate their antecedents. This study examined the contribution of safety climate-how frontline staff typically think about safety and act on safety issues-to adverse events in Veterans Affairs (VA) nursing homes or Community Living Centers (CLCs).

Design: Cross-sectional study.

Impact of Peer Specialist Services on Residential Stability and Behavioral Health Status Among Formerly Homeless Veterans With Cooccurring Mental Health and Substance Use Conditions.

Objectives: This study tested the impacts of peer specialists on housing stability, substance abuse, and mental health status for previously homeless Veterans with cooccurring mental health issues and substance abuse.

Methods: Veterans living in the US Housing and Urban Development-Veterans Administration Supported Housing (HUD-VASH) program were randomized to peer specialist services that worked independently from HUD-VASH case managers (ie, not part of a case manager/peer specialist dyad) and to treatment as usual that included case management services. Peer specialist services were community-based, using a structured curriculum for recovery with up to 40 weekly sessions.

Developing an outline for teleneurology curriculum: AAN Telemedicine Work Group recommendations.

The emerging field of teleneurology is delivering quality care to neurologic patients in increasingly numerous technologies and configurations. Teleneurology is well-positioned to address many of the logistical issues neurologists and their patients encounter today. However, formalized medical training has not caught up with this developing field, and there is a lack of formal education concentrating on the specific opportunities and challenges of teleneurology.

Forming and activating an internal facilitation group for successful implementation: A qualitative study.

Background: This study focuses on an implementation facilitation strategy to improve the delivery of anticoagulation care within pharmacy-run clinics across 8 Veterans Health Administration (VA) medical centers. Other studies have explored various models of implementation facilitation, including external facilitation (EF), internal facilitation (IF), and blended facilitation (BF) combining both approaches. This study focuses on the use of an internal facilitation team of anticoagulation coordinators representing 8 VA anticoagulation clinics to enhance the implementation process.

Predictors of Employment Burnout Among VHA Peer Support Specialists.

Objective: This study evaluated three domains of job burnout (emotional exhaustion, depersonalization, and personal accomplishment) and factors associated with burnout in a national sample of peer specialists (PSs) employed at 138 Veterans Health Administration (VHA) health care systems in 49 states.

Methods: Data were drawn from an observational study in which participants (N=152) completed online, self-report surveys about their mental health recovery, quality of life, and employment experiences at baseline, six months, and 12 months. Levels of burnout were analyzed at each time point, and regression analyses that controlled for baseline levels identified potential predictors of burnout (demographic, clinical, and employment characteristics) at six and 12 months.

Narratives to enhance smoking cessation interventions among African-American smokers, the ACCE project.

Background: Low-income, African-American smokers are less likely to have resources to aid in quitting smoking. Narrative communication may provide an enhancement to traditional smoking cessation interventions like NRT, medications, or behavioral treatments for this audience. After extensive pilot testing of stories and personal experiences with smoking cessation from African-Americans from a low-income community, we conducted a randomized control trial using stories to augment routine inpatient treatment among African-Americans at an urban Southern hospital (N = 300).

Knowing the patient: A qualitative study on care-taking and the clinical pharmacist-patient relationship.

Background: Previous studies have found clinical pharmacists (CPs) and clinical pharmacy specialists (CPSs) in direct patient care have positive effects across various patient outcomes. However, there are also other kinds of care-taking occurring in pharmacy-run clinic appointments that produce value for patients.

Objective: To identify and characterize how CPs/CPSs in direct care clinics develop and practice care-taking behaviors which advance the pharmacist-patient relationship.

The interplay of contextual elements in implementation: an ethnographic case study.

Background: Contextual elements have significant impact on uptake of health care innovations. While existing conceptual frameworks in implementation science suggest contextual elements interact with each other, little research has described how this might look in practice. To bridge this gap, this study identifies the interconnected patterns among contextual elements that influence uptake of an anticoagulation clinic improvement initiative.

Characteristics of patients who accept and decline ED rapid HIV testing.

Purpose: Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing.

Basic Procedures: This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12.

Delivering PACT-principled care: are specialty care patients being left behind?

Background: With the reorganization of primary care into Patient Aligned Care Teams (PACT) teams, the Veteran Affairs Health System (VA) aims to ensure all patients receive care based on patient-centered medical home (PCMH) principles. However, some patients receive the preponderance of care from specialty rather than primary care clinics because of the special nature of their clinical conditions. We examined seven VA (HIV) clinics as a model to test the extent to which such patients receive PCMH-principled care.

Outcome of a randomized study of a mental health peer education and support group in the VA.

Objectives: Study objectives were to compare mental health outcomes of a peer-led recovery group, a clinician-led recovery group, and usual treatment and to examine the effect of group attendance on outcomes.

Methods: The study used a randomized design with three groups: a recovery-oriented peer-led group (Vet-to-Vet), a clinician-led recovery group, and usual treatment. The sample included 240 veterans.

Coevolution of brain structures in amnestic mild cognitive impairment.

Network accounts of the progression of Alzheimer's disease (AD), based on cross-sectional brain imaging observations, postulate that the biological course of the disease is characterized by coordinated spatial patterns of brain change to distributed cognitive networks. This study tests this conjecture by quantifying inter-regional covariance in cortical gray matter atrophy rates in 317 Alzheimer's Disease Neuroimaging Initiative participants who were clinically diagnosed with amnestic mild cognitive impairment at baseline and underwent serial MRI at 6-month intervals over the course of 2years. A factor analysis model identified five factors (i.

Implementation challenges and functional outcome predictors for elder community-based disability prevention programs.

Background And Purpose: Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. However, it is often difficult to replicate clinical trials into real-world practice settings. We (a) compared replication and clinical trial functional changes, (b) compared replication and clinical trial program structures and processes of care, and, additionally, (c) examined how replication client and site features are associated with function.

Community-based disability prevention programs for elders: predictors of program completion.

Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. Program completion remains an important barrier to their effectiveness. We examined the association between provider relationships and client variables, and program completion in senior centers.

No less a man: reconstructing identity after prostate cancer.

Few diagnoses present as great a challenge to one's life as cancer. Many men each year are confronted with a diagnosis of early stage prostate cancer and find themselves making decisions about treatment in the face of side effects that present often devastating effects, including problems controlling one's urine and an inability to perform sexually. In this paper, we explore the narratives of men who, having chosen and undergone treatment for early stage prostate cancer, are living with the consequences.

Incentive implementation in physician practices: A qualitative study of practice executive perspectives on pay for performance.

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs.

Surface exposure of synaptosomal gangliosides from long-sleep and short-sleep mice.

A galactose oxidase/NaB[3H]4 technique was used to examine the relative surface exposure of gangliosides from whole brain synaptosomes of long-sleep (LS) and short-sleep (SS) mice. The surface exposure of the monosialoganglioside, GM1, did not differ between the two lines. Surface exposure of the polysialogangliosides GD1a, GD1b, and GT1b, however, was significantly greater in LS synaptosomes than in SS.

Ceramide composition of whole brain synaptosomal gangliosides from mice genetically bred for divergent ethanol sensitivities.

A comparison of the two major ceramide molecular species (d18:1-C18:0 and d20:1-C18:0) of synaptosomal gangliosides GM1, GD1a+GT1a, GD1b, GT1b, revealed a difference between the ceramide composition of ethanol-sensitive LS and ethanol-insensitive SS whole brain synaptosomal gangliosides. In all comparisons, the ratio of the two major molecular species, (d18:1-C18:0/d20:1-C18:0) was less for LS than for SS mice.

The short-term outcome of pressure sores.

Patients with pressure sores have been observed to have a poor prognosis. The short-term outcome of pressure sores at a long-term care hospital was therefore evaluated. Medical records on the 301 admissions to this hospital over a 13-month period were reviewed.