Antihypertensive Deprescribing and Functional Status in VA Long-Term Care Residents With and Without Dementia.

Background: Deprescribing antihypertensives is of growing interest in geriatric medicine, yet the impact on functional status is unknown. We emulated a target trial of deprescribing antihypertensive medications compared with continued use on functional status measured by activities of daily living (ADL) in a long-term care population.

Methods: We included 12,238 Veteran Affairs long-term care residents age 65+ who had a stay ≥ 12 weeks between 2006 and 2019.

Clerkship Students' Use of Clinical Reasoning Concepts After a Pre-clinical Reasoning Course.

Background: Many medical schools have incorporated clinical reasoning (CR) courses into their pre-clinical curricula to address the quality and safety issue of diagnostic error. It is unknown how students use concepts and practices from pre-clinical CR courses once in clerkships.

Objective: We sought to understand how students utilize CR concepts from a pre-clinical course during clerkships and to identify facilitators and barriers to the use of reasoning concepts.

Improving colonoscopy quality in the national VA healthcare system.

Background: Colorectal cancer (CRC) prevention is a Veterans Affairs (VA) priority. Colonoscopy quality, especially adenoma detection rate (ADR), is critical for effective screening. Our research indicates considerable variation in ADR among VA providers.

Trends in Opioid Use Disorder in the Veterans Health Administration, 2005-2022.

Importance: Given the personal and social burdens of opioid use disorder (OUD), understanding time trends in OUD prevalence in large patient populations is key to planning prevention and treatment services.

Objective: To examine trends in the prevalence of OUD from 2005 to 2022 overall and by age, sex, and race and ethnicity.

Design, Setting, And Participants: This serial cross-sectional study included national Veterans Health Administration (VHA) electronic medical record data from the VHA Corporate Data Warehouse.

Ecological Psychology: A Framework for Mentoring and Career Development in Academic Medicine.

Effective mentoring can help individuals navigate the complex, dynamic environment of academic medicine as they work to develop meaningful and fulfilling careers. Despite robust research into the characteristics of effective mentoring relationships and successful mentoring programs, resources that support mentors and mentees in engaging in career development in academic medicine are limited. Ecological psychology, a theory focusing on how the dynamic interplay between individuals and their environment influences cognition and behavior, offers a promising framework for exploring how mentors and mentees can support positive career development outcomes.

Antihypertensive Deprescribing and Cardiovascular Events Among Long-Term Care Residents.

Importance: The practice of deprescribing antihypertensive medications is common among long-term care residents, yet the effect on cardiovascular outcomes is unclear.

Objective: To compare the incidence of hospitalization for myocardial infarction (MI) or stroke among long-term care residents who are deprescribed or continue antihypertensive therapy.

Design, Setting, And Participants: This comparative effectiveness research study used target trial emulation with observational electronic health record data from long-term care residents aged 65 years or older admitted to US Department of Veterans Affairs community living centers between October 1, 2006, and September 30, 2019, and taking at least 1 antihypertensive medication.

EEG spectral attractors identify a geometric core of brain dynamics.

Multidimensional reconstruction of brain attractors from electroencephalography (EEG) data enables the analysis of geometric complexity and interactions between signals in state space. Utilizing resting-state data from young and older adults, we characterize periodic (traditional frequency bands) and aperiodic (broadband exponent) attractors according to their geometric complexity and shared dynamical signatures, which we refer to as a geometric cross-parameter coupling. Alpha and aperiodic attractors are the least complex, and their global shapes are shared among all other frequency bands, affording alpha and aperiodic greater predictive power.

Performance of a Short Version of the Everyday Cognition Scale (ECog-12) to Detect Cognitive Impairment.

Background: The Everyday Cognition (ECog) 12-item scale, a functional decline measurement, can distinguish dementia from cognitively unimpaired (CU). Limited data compare ECog-12 performance by raters (self vs. informant) and scoring systems (average numeric vs.

Use of mobile applications and mental health services among veterans who received internet-connected tablets.

Objectives: Among Veterans Health Administration (VHA) patients receiving internet-connected tablets, we examined (1) app usage, (2) clusters of commonly used apps and patient characteristics across clusters, and (3) the relationship between app clusters and mental health services.

Materials And Methods: A survey was distributed to a national sample of VHA patients ( = 5449) within 6 months of tablet receipt. Self-reported app use was clustered with agglomerative hierarchical clustering.

A pilot study of a scalable training programme for coaches delivering webSTAIR.

Accessible, low-cost digital programmes are emerging as a means by which to address high rates of mental health problems. However, the development and assessment of scalable training programmes for effective use of digital interventions has lagged. This is particularly important, as coach-supported digital interventions provide benefits that substantially and consistently exceed those of programmes that are entirely self-guided.

A use case of ChatGPT: summary of an expert panel discussion on electronic health records and implementation science.

Objective: Artificial intelligence (AI) is revolutionizing healthcare, but less is known about how it may facilitate methodological innovations in research settings. In this manuscript, we describe a novel use of AI in summarizing and reporting qualitative data generated from an expert panel discussion about the role of electronic health records (EHRs) in implementation science.

Materials And Methods: 15 implementation scientists participated in an hour-long expert panel discussion addressing how EHRs can support implementation strategies, measure implementation outcomes, and influence implementation science.

A diet-dependent host metabolite shapes the gut microbiota to protect from autoimmunity.

Diet can protect from autoimmune disease; however, whether diet acts via the host and/or microbiome remains unclear. Here, we use a ketogenic diet (KD) as a model to dissect these complex interactions. A KD rescued the experimental autoimmune encephalomyelitis (EAE) mouse model of multiple sclerosis in a microbiota-dependent fashion.

Protective Factors Predict Resilient Outcomes in Clinical High-Risk Youth with the Highest Individualized Psychosis Risk Scores.

Background And Hypothesis: Studying individuals at Clinical High Risk (CHR) for psychosis provides an opportunity to examine protective factors that predict resilient outcomes. Here, we present a model for the study of protective factors in CHR participants at the very highest risk for psychotic conversion based on the Psychosis Risk Calculator.

Study Design: CHR participants (N = 572) from NAPLS3 were assessed on the Risk Calculator.

Frailty measures in multiple myeloma: evaluating the impact on outcomes and quality-of-life in clinical trials and real-world practice.

Multiple myeloma is a hematologic malignancy that predominantly affects older individuals, in whom frailty is prevalent. Frailty is a clinical syndrome characterized by decreased reserve and increased vulnerability to stressors, leading to decreased functional capacity. Frailty is prevalent in older individuals and negatively impacts treatment outcomes.

A (sub)field guide to quality control in hippocampal subfield segmentation on high-resolution T-weighted MRI.

Inquiries into properties of brain structure and function have progressed due to developments in magnetic resonance imaging (MRI). To sustain progress in investigating and quantifying neuroanatomical details in vivo, the reliability and validity of brain measurements are paramount. Quality control (QC) is a set of procedures for mitigating errors and ensuring the validity and reliability of brain measurements.

Changes in Sources of Information about the Risks and Benefits of Cannabis in a National Cohort of US Adults from 2017 - 2021.

Objective: As more states legalize cannabis in the US, marketing from the cannabis industry and news coverage of cannabis have increased. Sources of information on cannabis can influence beliefs about risks and benefits. Yet, little is known about how the use and influence of specific sources of information have changed over time.