Vascular Access Guidelines: Summary, Rationale, and Controversies.

Dialysis vascular access management in the United States changed significantly after National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-KDOQI) clinical practice guidelines were first published in 1997. The Centers for Medicare and Medicaid Service adopted these guidelines and in collaboration with the End-Stage Renal Disease Networks established the Fistula First Breakthrough Initiative (FFBI) in 2003 to improve the rate of arteriovenous fistula use over arteriovenous graft and central venous catheter in the dialysis population. The implementation of guidelines and FFBI has led to a significant increase in the arteriovenous fistula use in the prevalent dialysis population.

Word Memory Test Performance Across Cognitive Domains, Psychiatric Presentations, and Mild Traumatic Brain Injury.

Objective: The current study addressed two aims: (i) determine how Word Memory Test (WMT) performance relates to test performance across numerous cognitive domains and (ii) evaluate how current psychiatric disorders or mild traumatic brain injury (mTBI) history affects performance on the WMT after excluding participants with poor symptom validity.

Method: Participants were 235 Iraq and Afghanistan-era veterans (Mage = 35.5) who completed a comprehensive neuropsychological battery.

Sleep quality affects cognitive functioning in returning combat veterans beyond combat exposure, PTSD, and mild TBI history.

Objective: The purpose of this study was to determine how sleep quality affects cognitive functioning in returning combat veterans after accounting for effects of combat exposure, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) history.

Method: This was a cross-sectional assessment study evaluating combat exposure, PTSD, mTBI history, sleep quality, and neuropsychological functioning. One hundred and nine eligible male Iraq/Afghanistan combat veterans completed an assessment consisting of a structured clinical interview, neuropsychological battery, and self-report measures.

Lower Extremity Permanent Dialysis Vascular Access.

Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers.

Neuropsychological assessment of a veteran with a large arachnoid cyst.

Arachnoid cysts are benign, congenital masses that are believed to form when the arachnoid membrane splits or is duplicated and the resulting space fills with fluid. Despite their potentially alarming appearance on brain imaging, congenital cysts discovered in adulthood are usually silent and do not result in functional impairment. A left-handed male veteran with mild memory complaints was discovered to have a large (16.

Distress Tolerance and Impulsivity Are Associated With Drug and Alcohol Use Consequences in an Online Community Sample.

Impulsivity and distress tolerance (DT) have been implicated as key features in development and maintenance of substance use disorders. This study expanded on previous research by exploring the four factors of DT (Absorption, Appraisal, Regulation, Tolerance) and their interaction with impulsivity in relation to substance use. Participants were 105 men and 150 women who completed measures of impulsivity, DT, and substance use.

Auditory Consonant Trigrams: A Psychometric Update†.

The Auditory Consonant Trigrams (ACT) test was developed to evaluate immediate memory in the absence of rehearsal. There are few psychometric studies of the measure and a lack of normative data using samples from the United States or Veterans. ACT data were examined for 184 participants who passed the Word Memory Test, denied a history of moderate to severe traumatic brain injury (TBI), and consented for research purposes only.

Pre-Access Creation Evaluation--Is Vein Mapping Enough?

The changing demographic of the hemodialysis population in the United States is posing significant challenge for selection and creation of an optimal vascular access. An arteriovenous fistula (AVF) is by far the most reliable access provided it matures and functions successfully. System-wide changes implemented by Fistula First Breakthrough Initiative and Kidney Disease Outcomes Quality Initiative guidelines have increased the awareness and incidence of AVF in the prevalent dialysis population; however, achieving the current goal of 68% AVF rate continues to remain elusive.

Embedded Performance Validity Measures with Postdeployment Veterans: Cross-Validation and Efficiency with Multiple Measures.

Embedded validity measures support comprehensive assessment of performance validity. The purpose of this study was to evaluate the accuracy of individual embedded measures and to reduce them to the most efficient combination. The sample included 212 postdeployment veterans (average age = 35 years, average education = 14 years).

Alert Hypnotic Inductions: Use in Treating Combat Post-Traumatic Stress Disorder.

Alert hypnosis can be a valuable part of the treatment protocol for the resolution of post-traumatic stress disorder (PTSD). Research indicates that combat veterans with PTSD are more hypnotically susceptible than the general population. For that reason, it is hypothesized that they should be better able to use hypnosis in treatment.

Neuropsychological Function in a Case of Dandy-Walker Variant in a 68-Year-Old Veteran.

Dandy-Walker syndrome (DWS) is a congenital brain malformation that is characterized by partial or complete agenesis of the cerebellar vermis and cystic dilatation of the 4th ventricle that shifts ventrolaterally to displace the cerebellar hemispheres. This case is a 68-year-old male veteran with complaints of new-onset cognitive disorder who was found to have previously unsuspected DWS on head computed tomography. This is one of the first case studies to present complete neuropsychological test results in a veteran with DWS.

Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology.

Objective: Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans.

Factor structure and construct validity of the Behavioral Dyscontrol Scale-II.

The Behavioral Dyscontrol Scale-II (BDS-II) was developed as an improved scoring method to the original BDS, which was designed to evaluate the capacity for independent regulation of behavior and attention. The purpose of this study was to evaluate the factor structure and construct validity of the BDS-II, which had not been adequately re-examined since the development of the new scoring system. In a sample of 164 Veterans with a mean age of 35 years, exploratory factor analysis was used to evaluate BDS-II latent factor structure.

The Behavioral Dyscontrol Scale-II with non-elderly veterans.

The Behavioral Dyscontrol Scale-II (BDS-II) is a unique test of frontal lobe function. Although the test was created for use in geriatric populations, it can add useful data to assessments of non-elderly patients. The original scoring system for the BDS was characterized by a low ceiling, limiting its use with higher functioning populations.

Elderly patients with CKD--dilemmas in dialysis therapy and vascular access.

The population of elderly patients with end-stage renal disease (ESRD) is growing rapidly worldwide. The high prevalence of comorbidities, limited life expectancy and complex quality of life issues associated with this population pose substantial challenges for clinicians in terms of clinical decision-making and providing optimal care. The first dilemma encountered in the management of an elderly patient with ESRD is deciding whether to initiate renal replacement therapy and, if so, selecting the most-suitable dialysis modality.

Safety of brachial arteriogram using a 3-French dilator to evaluate nonmaturing arteriovenous fistulae.

Nonmaturing arteriovenous fistula remains a hurdle in improving the fistula rate in the hemodialysis population. Timely referral can assist in salvaging fistula with endovascular interventions. Pathology at the inflow segment is frequently encountered as a primary reason for maturation failure.

Comparison of a pharmacist-managed lipid clinic: in-person versus telephone.

Objective: To compare the effectiveness of an in-person versus telephone-based pharmacist-managed lipid clinic.

Methods: Retrospective examination of a pharmacist-managed lipid clinic conducted at a Veterans Affairs medical center between September 2005 and March 2008. The clinical pharmacist educated, monitored, recommended nonpharmacologic treatment, and prescribed lipid-lowering medications using an in-person or telephone-based clinic style.

Nonclassic retinitis pigmentosa: A challenging clinical diagnosis solved by pedigree analysis and electrodiagnostic testing.

Purpose: The aim of this study was to describe a case of nonclassic retinitis pigmentosa, to highlight ancillary testing tools for proper diagnosis, and to differentiate between common hereditary fundus dystrophies.

Methods: Methods used in this study included complete ophthalmologic evaluation, optical coherence tomography, visual field testing, pedigree analysis, and electrodiagnostic testing.

Results: Reduced vision and photopsia were the initial complaints of a patient who had an overall normal ocular appearance.