Provider and staff perceptions of veterans' attrition from a national primary care weight management program.

Background: Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness.

Objectives: This study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!(®) Weight Management Program as an initial step toward understanding attrition from primary care-based programs.

Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer screening.

Background: HIV-infected persons have a two-fold to five-fold increased unadjusted risk of lung cancer. In the National Lung Screening Trial (NLST), computed tomography (CT) screening was associated with a reduction in lung cancer mortality among high-risk smokers. These results may not generalize to HIV-infected persons, particularly if they are more likely to have false-positive chest CT findings.

WNT signaling pathway gene polymorphisms and risk of hepatic fibrosis and inflammation in HCV-infected patients.

Background: Chronic hepatitis C infection is the leading cause of hepatocellular carcinoma (HCC), a highly lethal malignancy with rapidly increasing prevalence in the United States. Little is known about genetic variations and HCC risk. This study aimed to determine if genetic variation in Wnt signaling pathway genes are associated with advanced hepatic fibrosis and inflammation risk in a hepatitis C virus (HCV) infected population.

Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial.

Importance: Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested.

Objective: To test the 2 independent hypotheses that, compared with placebo, addition of low-dose dopamine (2 μg/kg/min) or low-dose nesiritide (0.005 μg/kg/min without bolus) to diuretic therapy will enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction.

Can personality traits predict the future development of heart disease in hospitalized psychiatric veterans?

Objective: To examine which personality traits are associated with the new onset of chronic coronary heart disease (CHD) in psychiatric inpatients within 16 years after their initial evaluation. We theorized that personality measures of depression, anxiety, hostility, social isolation, and substance abuse would predict CHD development in psychiatric inpatients.

Method: We used a longitudinal database of psychological test data from 349 Veterans first admitted to a psychiatric unit between October 1, 1983, and September 30, 1987.

Management of gastric polyps: an endoscopy-based approach.

The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions that have not been addressed in formal guidelines: do all polyps need to be excised, or can they just be sampled for biopsy? If so, which ones and how many should be sampled? What follow-up evaluation is needed, if any? This review relies on the existing literature and our collective experience to provide practical answers to these questions. Fundic gland polyps, now the most frequent gastric polyps in Western countries because of widespread use of proton pump inhibitors, and hyperplastic polyps, the second most common polyps notable for their association with gastritis and their low but important potential for harboring dysplastic or neoplastic foci, are discussed in greater detail. Adenomas have had their name changed to raised intraepithelial neoplasia and are decreasing in parallel with Helicobacter pylori infection; however, they do retain their importance as harbingers of gastric cancer, particularly in East Asia.

Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: a case-control study.

Objective: Abdominal obesity has been associated with increased risk of Barrett's oesophagus (BE) but the underlying mechanism is unclear. We examined the association between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and the risk of BE.

Design: A case-control study among eligible patients scheduled for elective oesophagastroduodenoscopy (EGD) and in a sample of patients eligible for screening colonoscopy recruited at the primary care clinic.

Incidence and survival of colorectal cancer among Hispanics in the United States: a population-based study.

Background: Hispanics are the largest and fastest growing ethnic group in the United States (US).

Aims: We evaluated the incidence and survival of colorectal cancer (CRC) among this population.

Methods: Data from the surveillance, epidemiology, and end results program were used to calculate CRC age-adjusted and age-specific incidence rates in Hispanics during 1993-2007.

Staphylococcus aureus Bacteriuria: Source, Clinical Relevance, and Management.

Staphylococcus aureus bacteriuria is a common condition with still largely undetermined clinical relevance. Although S. aureus bacteriuria can be secondary to bacteremia and systemic infection in some patients, it may predispose to bacteremia and invasive disease in others.

Therapy in the West.

Increasing antimicrobial resistance has continued to plague successful anti- eradication therapy. With rare exception, clarithromycin-containing triple therapy now provides unacceptably low treatment success. Here we discuss the factors that influence treatment outcome, how to predict outcome with new regimens, the 4-drug regimens that are currently effective in the West and their limitations, considerations about the approach to treatment failures and finally, based on the experience in the West, provide recommendations for choosing an empiric regimen in Japan.

Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes.

Background: The aims of the present study were to derive a foot risk index using administrative data similar to the International Working Group on the Diabetic Foot clinical risk classification scheme and to evaluate its association with the risk of initial lower extremity (through foot or above) amputation (ILEA).

Methods: Merged Veterans Health Administration administrative and Medicare inpatient and outpatient claims data for a historical cohort of Veterans Health Administration users with diabetes were analyzed. Individuals with diabetes, aged ≥67 years in 1999, were classified into seven foot risk categories (where 0=no foot risk conditions; and 6=severe foot conditions).

A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance.

Background: Pulmonary hypertension (PH), a disease which carries substantial morbidity and mortality, has been reported to occur in 25%-45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US) has been undertaken.

Methods: Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center.

Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States.

Unlabelled: Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended but may not be performed. The extent and determinants of HCC surveillance are unknown. We conducted a population-based United States cohort study of patients over 65 years of age to examine use and determinants of prediagnosis surveillance in patients with HCC who were previously diagnosed with cirrhosis.

Severe aortic stenosis in a veteran population: treatment considerations and survival.

Background: We examined factors affecting the choice of surgical versus medical treatment of severe aortic stenosis and evaluated associated patient survival.

Methods: We retrospectively reviewed data from all patients diagnosed with severe aortic stenosis at a Veterans Affairs medical facility between January 1997 and April 2008.

Results: Of 345 patients with severe aortic stenosis, 260 (75%) underwent surgical evaluation, and 205 (59%) underwent aortic valve replacement (AVR).

Chronic widespread pain, mental health, and physical role function in OEF/OIF veterans.

Objective: Describe the associations among pain, mental health concerns, and function in veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).

Design: Retrospective review of self-reported, standardized clinical intake surveys.

Setting: A multidisciplinary deployment health clinic at a Veterans Affairs (VA) medical center.

Phase IB trial of oral talactoferrin in the treatment of patients with metastatic solid tumors.

Purpose: We evaluated safety and activity of talactoferrin, a novel immunomodulatory protein in a phase IB trial of patients with refractory solid tumors.

Methods: Thirty-six patients with metastatic cancer who had progressed on, or were ineligible for, standard chemotherapy received single-agent oral talactoferrin. Following dose-escalation, with no DLTs , patients were randomized to 4.

Sex differences in medical care and early death after acute myocardial infarction.

Background: Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era.

Methods And Results: Using the Get With the Guidelines-Coronary Artery Disease database, we examined sex differences in care processes and in-hospital death among 78 254 patients with AMI in 420 US hospitals from 2001 to 2006.

Knowledge management: how to keep up with the literature.

With the increasing medical literature, staying current with medical information is becoming a major challenge for clinicians. To ensure best practice and treatment for patients, clinicians must access medical information, acquire new knowledge, and achieve information mastery in their field. Without a systematic approach to identify and critically appraise clinical research, they might become dependent on inappropriate or outdated information.

National mortality following upper gastrointestinal or cardiovascular events in older veterans with recent nonsteroidal anti-inflammatory drug use.

Background: Upper gastrointestinal events (UGIE), myocardial infarction (MI) and cerebrovascular accident (CVA) are known morbidities among recent NSAID users.

Aim: To assess all-cause mortality following UGIE, MI or CVA among recent NSAID users.

Methods: Veterans >65 prescribed an NSAID at any Veterans Affairs (VA) facility were identified using prescription fill data and their records linked to a merged VA-Medicare database.