Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

Objective: Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management.

Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center.

We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation.

Microbial DNA testing for inflammatory diseases of the brain of uncertain etiology.

Neurologists may be confronted with patients who present with inflammatory brain lesions where the diagnosis cannot be made through history and physical examination alone. Molecular testing for bacterial infections, tuberculosis, and fungal infections may aid in the diagnosis. Since the treatments for these disorders are different and delays can result in permanent neurologic disability and death, rapid and accurate diagnoses are critical.

Fatigue is associated with poor sleep in people with multiple sclerosis and cognitive impairment.

Background. Fatigue is the most common symptom in people with multiple sclerosis (MS). Poor sleep also occurs in this population.

Visual symptomatology and referral patterns for Operation Iraqi Freedom and Operation Enduring Freedom veterans with traumatic brain injury.

Advances in protective armor technology and changes in the "patterns of war" have created a population of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with traumatic brain injury (TBI) that provide a unique challenge to Department of Veterans Affairs (VA) healthcare practitioners. The purpose of the study was to determine the frequency of symptomatic ocular and visual sequelae of TBI in OIF/OEF veterans at the Portland VA Medical Center, a Polytrauma Support Clinic Team site. A retrospective analysis of 100 OIF/OEF veterans with TBI was conducted to determine the prevalence of ocular and visual complaints.

Performance on tests of central auditory processing by individuals exposed to high-intensity blasts.

Thirty-six blast-exposed patients and twenty-nine non-blast-exposed control subjects were tested on a battery of behavioral and electrophysiological tests that have been shown to be sensitive to central auditory processing deficits. Abnormal performance among the blast-exposed patients was assessed with reference to normative values established as the mean performance on each test by the control subjects plus or minus two standard deviations. Blast-exposed patients performed abnormally at rates significantly above that which would occur by chance on three of the behavioral tests of central auditory processing: the Gaps-In-Noise, Masking Level Difference, and Staggered Spondaic Words tests.

Falls requiring medical attention among veterans with multiple sclerosis: a cohort study.

The purpose of this study was to estimate the relative risk of an injurious fall requiring medical attention in veterans with multiple sclerosis (MS) compared with veterans without MS after controlling for sex, age, and healthcare use. The sample included 195,417 veterans treated at Veterans Health Administration (VHA) facilities in the Northwest United States in fiscal year 2008. We obtained information regarding MS diagnosis, injurious falls (operationalized as International Classifi cation of Diseases-9th Revision-Clinical Modification codes E880-E888), and demographic and healthcare use data from the VHA Consumer Health Information Performance Set database.

Development of a protocol for capillary blood glucose testing in nursing home and rehabilitation settings.

Objectives: To develop an algorithm to standardize capillary blood glucose (CBG) testing in nursing home and rehabilitation patients.

Design: Descriptive study in which an interdisciplinary team from a nursing home, a rehabilitation center, and a diabetes mellitus care program developed and tested a protocol to standardize diabetes management parameters and CBG testing frequency.

Setting: Department of Veterans Affairs nursing home and rehabilitation unit.

Expression profiling identifies strain-specific changes associated with ethanol withdrawal in mice.

Mice that exhibit characteristics of physical dependence following ethanol exposure serve as useful models of alcoholism in humans. The DBA/2J and C57BL/6J inbred strains differ in their behavioral response to ethanol withdrawal. Alterations in gene expression are believed to underlie neuroadaptation to ethanol dependence and tolerance.

Predictors of outcome of forefoot surgery for ulceration and gangrene.

Background: Surprisingly little is known about the long-term outcome of forefoot surgery for limb salvage.

Methods: From January 1, 1992 through December 31, 1996, patients requiring toe amputation or forefoot surgery were prospectively entered into a computerized database and followed up for healing, need for repeat foot surgery, or major amputation (below or above knee).

Results: A total of 162 patients (mean age 65 years), 72% diabetic, 10% with end-stage renal disease (ESRD), and 73% without palpable pulses, were entered into the study.

Effectiveness of an ambulatory care clinical pharmacist: a controlled trial.

Objective: To compare two general medicine clinics to determine the effectiveness of an ambulatory care clinical pharmacist in assisting recognition of drug therapy problems for physicians and decreasing drug therapy costs.

Design: Controlled trial.

Setting: Two general medicine ambulatory care clinics associated with a large, tertiary-care teaching hospital.