Patient Insights on Integrating Sleep Apnea Testing into Routine Stroke and TIA Care.

AHA/ASA guidelines recommend patients with ischemic stroke or transient ischemic attack (TIA) be considered for obstructive sleep apnea (OSA) evaluation, given the high prevalence of OSA and improved outcomes for cerebrovascular disease when OSA is treated. However, OSA testing has not been incorporated into routine cerebrovascular management. We interviewed 30 patients hospitalized for acute stroke/TIA at six Veterans Affairs facilities participating in a stepped-wedge implementation trial to improve timely OSA testing after stroke/TIA.

Patient-derived response estimates from zero-passage organoids of luminal breast cancer.

Background: Primary luminal breast cancer cells lose their identity rapidly in standard tissue culture, which is problematic for testing hormone interventions and molecular pathways specific to the luminal subtype. Breast cancer organoids are thought to retain tumor characteristics better, but long-term viability of luminal-subtype cases is a persistent challenge. Our goal was to adapt short-term organoids of luminal breast cancer for parallel testing of genetic and pharmacologic perturbations.

The effect of a Veterans Affairs rapid rehousing and homelessness prevention program on long-term housing instability.

Objective: To evaluate the effect of enrolling in Supportive Services for Veteran Families (SSVF) on short- and long-term housing outcomes among Veterans experiencing housing instability.

Study Setting And Design: We analyzed data from the Department of Veterans Affairs (VA) electronic health record (EHR) between October 2015 and December 2018 using the target trial emulation framework. Veterans were included in one or more trials if they were 18 years or older, had recent evidence of housing instability, had received care in VA for at least 1 year, and had never before enrolled in SSVF.

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.

Assessment of Racial Bias within the Risk Analysis Index of Frailty.

Objective: Our objective was to assess potential racial bias within the Risk Analysis Index (RAI).

Background: Patient risk measures are rarely tested for racial bias. Measures of frailty, like the RAI, need to be evaluated for poor predictive performance among Black patients.

Sexual orientation and sexual functioning in midlife women veterans.

Objective: Midlife women experience menopause- and aging-related health changes that may impact sexual functioning. Research has historically relied on heteronormative constructs of sexuality, and little is known about the experiences of sexual minority women (SMW) during menopause. We therefore examined whether indices of sexual function differed between SMW and heterosexual midlife women Veterans.

Exploring Racial and Ethnic Differences in Utilization of Medications for Obesity Management in a Nationally Representative Survey.

Background: The burden of obesity falls disproportionately on some racial and ethnic minority groups.

Objective: To assess for racial and ethnic differences in the utilization of obesity-management medications among clinically eligible individuals.

Design: Medical Expenditure Panel Survey (2011-2016, 2018 and 2020) data and a cross-sectional study design was used to assess for racial and ethnic differences in obesity-management medication utilization.

Mental Health Provider Knowledge and Attitudes Toward Diagnosing Anxiety Disorders in the Veterans Health Administration.

Clinical practice guidelines indicate treatments for specific anxiety diagnoses. Misdiagnosing specific anxiety disorders as unspecified anxiety may prevent patients from receiving appropriate care. Provider knowledge and attitudes may influence diagnostic practices.

Prevalence and Outcomes of Emergency Presentations of Colorectal Cancer in Veterans Affairs Health Care System.

Background: Colorectal cancer (CRC) diagnoses are frequently made through emergency presentations (EPs), a new cancer diagnosis following an emergency care episode or unplanned inpatient admission. The extent and implications of EPs are not well known in the Veterans Affairs (VA) health system, where robust CRC screening protocols exist. The impact of the COVID-19 pandemic on the route of CRC diagnosis also remains unclear.

Serum levels of total bile acids are associated with an increased risk of HCC in patients with cirrhosis.

Background: Previous studies have reported higher circulating bile acid levels in patients with HCC compared to healthy controls. However, the association between prediagnostic bile acid levels and HCC risk among patients with cirrhosis is unclear.

Methods: We measured total BA (TBA) concentration in serum samples collected from a prospective cohort of patients with cirrhosis who were followed until the development of HCC, death, or last study date.

Cohort Profile: Baseline Characteristics of Veterans from Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) - an Embedded Pragmatic, Cluster Randomized Trial in the United States.

Purpose: AIM-Back is an embedded pragmatic clinical trial (ePCT) with cluster randomization designed to increase access and compare the effectiveness of two different non-pharmacological care pathways for low back pain (LBP) delivered within the Veteran Administration Health Care System (VAHCS). This manuscript describes baseline characteristics of AIM-Back participants as well as the representativeness of those referred to the AIM-Back program by sex, age, race, and ethnicity, relative to Veterans with low back pain at participating clinics.

Participants: To be eligible for AIM-Back, Veterans were referred to the randomized pathway at their clinic by trained primary care providers (Referral cohort).

Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals.

Background: Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans.

Objective: To evaluate the burden of AUD in admissions at rural and urban hospitals within the Veterans Health Administration (VHA) comparing patient characteristics, clinical outcomes, and 1-, 3-, and 5-year mortality rates.

Methods: Retrospective cross-sectional study of patients admitted to VHA hospitals from 2016 to 2020, with a primary or secondary diagnosis related to AUD.

Training an Embedded Workforce to Realize Health System Impacts and the Promise of Learning Health Systems Comment on "Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program".

Learning health systems (LHSs) are designed to systematically integrate external evidence of effective practices with internal data and experience to put knowledge into practice as a part of a culture of continuous learning and improvement. Researchers embedded in health systems are an essential component of LHSs, with defined competencies. However, many of these competencies are not generated by traditional graduate/post-graduate training programs; evaluation of new LHS training programs has been limited.

Early combination therapy with SGLT2i and GLP-1 RA or dual GIP/GLP-1 RA in type 2 diabetes.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-Like peptide-1 receptor agonists (GLP-1 RA) are recommended in people with type 2 diabetes (T2D) for glycaemic control and for people with high cardiovascular risk. However, current guidelines do not specifically address the role of initial early combination therapy with SGLT2i and GLP-1 RA or dual gastric inhibitory polypeptide (GIP)/GLP-1 RA, but rather sequential initiation with either in T2D. This review synthesizes the available evidence on the use of SGLT2i and GLP-1-based therapies for T2D and provides a rationale for their combination.

SDMPH 10-year Anniversary Conference Modified Delphi Study.

Objectives: The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.

Methods: Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale.

Interval Advanced Adenomas and Neoplasia in Patients with Negative Colonoscopy Following Positive Stool-Based Colorectal Cancer Screening Test.

Background/aims: Fecal occult blood test (FOBT) and fecal immunohistochemical test (FIT) are used for colorectal cancer (CRC) screening. However, when no adenomas are found following a positive FOBT/FIT, the future risk of advanced adenomas or colorectal cancer (CRC) is unclear. We determined the incidence and determinants of advanced adenomas or CRC after a negative index colonoscopy following a positive FOBT/FIT.

Patient-psychologist telemedicine interactions in an intensive care unit recovery clinic: Qualitative secondary analysis.

Objectives: We aimed to describe the content of patient-psychologist mental health related dialogues during a telemedicine intensive care unit recovery clinic visit.

Research Methodology/design: Qualitative descriptive study nested within a randomized controlled pilot trial to assess a telemedicine intensive care unit recovery clinic feasibility and preliminary efficacy. Participants included adults hospitalized with sepsis and/or respiratory failure.

Veterans' Lung Cancer Risk Conceptualizations versus Lung Cancer Screening Shared Decision-Making Conversations with Clinicians: A Qualitative Study.

Background: The Veterans Health Administration (VA) recommends lung cancer screening (LCS), including shared decision making between clinicians and veteran patients. We sought to characterize 1) veteran conceptualization of lung cancer risk and 2) veteran and clinician accounts of shared decision-making discussions about LCS to assess whether they reflect veteran concerns.

Methods: We conducted qualitative interviews at 6 VA sites, with 48 clinicians and 34 veterans offered LCS in the previous 6 mo.

An approach to evaluation of digital data in public health campaigns.

Unlabelled: Mass media campaigns for public health often rely heavily on digital media and advertising tools that are customarily the domain of marketing professionals and primarily used for commercial purposes. Digital campaigns also generate a myriad of metrics, which can pose both a challenge and opportunity for scientists wishing to leverage these data for research and evaluation.

Objective: The aim of this article is to provide practical guidance for the evaluation of paid media campaigns, with a focus on analyzing digital data generated directly by the campaign.

Cannabis Use and Cannabis Use Disorder Among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013.

Background: Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Administration (VA) patients with psychiatric disorders compared to patients with no disorder. However, VA patient samples are not representative of all U.S.