A Reflection and Discussion Exercise on Racial Justice and Equity.

Background: Residents have valuable perspectives about diversity and equity in medical training, yet many graduate medical education curricula lack dedicated activities focused on such issues.

Objectives: To describe and report feasibility and acceptability of an innovation that uses individual reflection and group discussion to create conversation in our residency program about equity and injustice through the lens of the Black Lives Matter movement.

Methods: In July 2020, we sent a survey with reflection prompts to all postgraduate year 2 and above internal medicine residents.

Comparison of cat and human calcium oxalate monohydrate kidney stone matrix proteomes.

Despite its critical nature, the role of matrix in calcium oxalate stone formation is poorly understood. The wide diversity of proteins comprising matrix has contributed to the ambiguity. This study compares the protein distributions measured by mass spectrometry in human calcium oxalate stone matrix to that observed in cat stone matrix, because cats share many clinical characteristics of their stone disease with humans.

Burnout and Turnover Intention in Critical Care Professionals During the COVID-19 Pandemic in Japan: A Cross-sectional Survey.

The prevalence of burnout among critical care professionals during the coronavirus disease (COVID-19) pandemic varies in different countries. To investigate the prevalence of burnout and turnover intention in Japanese critical care professionals in March 2021. This cross-sectional study used a web-based survey of Japanese critical care professionals working in 15 intensive care units in 15 prefectures.

Association of Social Risk Domains With Poor Cardiovascular Risk Factor Control in US Adults With Diabetes, From 2006 to 2016.

Importance: Few studies have examined the association between social risk factors and poor control of cardiovascular disease (CVD) risk factors.

Objective: To examine the sequential association between social risk domains and CVD risk control over time in older adults with diabetes.

Design, Setting, And Participants: This cohort study analyzed core interviews from 4877 US adults with diabetes who were participating in the Health and Retirement Study, a national longitudinal survey of US adults.

Cross-Sector Collaborations Between Health Care Systems and Community Partners That Target Health Equity/Disparities in Diabetes Care.

Evidence shows that social determinants of health (SDOH) are key drivers of diabetes outcomes and disparities in diabetes care. Targeting SDOH at the individual, organizational, and policy levels is an essential step in improving health equity for individuals living with diabetes. In addition, there is increasing recognition of the need to build collaboration across the health care system and the communities experiencing inequities to improve health equity.

Tapered Dose Postoperative Opioid Prescriptions Following Inpatient Total Hip and Knee Arthroplasty: Quality Improvement Study and Retrospective Review.

Background: Overprescription of pain medications directly fuels the opioid epidemic. Veterans are profoundly impacted. Tapered dose protocols may reduce excessive prescribing.

Client perspectives on psychotherapy failure.

This study qualitatively examined client's definition and experiences of failed psychotherapy. Thirteen clients were interviewed by phone regarding their experience of failed psychotherapy. Data were analyzed using consensual qualitative research (CQR).

Medial orbital wall decompression: Demographics influencing surgical follow-up and complications: Impacts on follow-up and complications.

Objective: Identify the impact of demographics and social determinants of health on surgical follow-up and complications after medial orbital wall decompression (MOWD) secondary to thyroid associated orbitopathy (TAO).

Methods: Demographics and social determinants of health (age, sex, race, insurance status) for 46 patients undergoing MOWD secondary to TAO were correlated with post-operative compliance and surgical complications by chi-square analyses.

Results: Among 46 patients, 23 were compliant with follow-up.

Lead and Pulse Generator Migration After Spinal Cord Stimulation Implantation: Insights From an Analysis of 7322 Patients.

Objectives: Lead migration (LM) after spinal cord stimulation (SCS) implantation surgery is the most common device-related complication. Our study of lead and implantable pulse generator (IPG) migration using a large administrative claims data base aims to understand rates, risk factors, and outcomes after SCS implantation.

Materials And Methods: This retrospective cohort study used the IBM® MarketScan® (Armonk, NY) Commercial and Medicare Supplemental Databases from 2016 to 2018.

Control of a Wheelchair-Mounted 6DOF Assistive Robot With Chin and Finger Joysticks.

Throughout the last decade, many assistive robots for people with disabilities have been developed; however, researchers have not fully utilized these robotic technologies to entirely create independent living conditions for people with disabilities, particularly in relation to activities of daily living (ADLs). An assistive system can help satisfy the demands of regular ADLs for people with disabilities. With an increasing shortage of caregivers and a growing number of individuals with impairments and the elderly, assistive robots can help meet future healthcare demands.

Consensus Quality Measures and Dose Constraints for Rectal Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology (ASTRO) Expert Panel.

Purpose: Ensuring high quality, evidence-based radiation therapy for patients with cancer is of the upmost importance. To address this need, the Veterans Affairs (VA) Radiation Oncology Program partnered with the American Society for Radiation Oncology and established the VA Radiation Oncology Quality Surveillance program. As part of this ongoing effort to provide the highest quality of care for patients with rectal cancer, a blue-ribbon panel comprised of rectal cancer experts was formed to develop clinical quality measures.

Hot Tub Lung: Case Report and Review of the Literature.

Introduction: Nontuberculous mycobacteria-related hypersensitivity pneumonitits (NTM-HP), otherwise known as hot tub lung, is an uncommon disease produced by exposure to aerosolized hot tub water containing nontuberculous mycobacteria. Patients usually present with nonspecific, prolonged respiratory symptoms and require a thorough respiratory workup, including radiography and even pulmonary biopsies.

Case Presentation: We present the case of a 58-year-old patient with chronic respiratory symptoms and history of exposure to a hot tub.

The Effect of Weather and Sporting Events on Ambulatory Visits and Hospitalizations at a Veterans Affairs Medical Center.

Background: We explored the impact of weather and sporting events on clinic and emergency department (ED) visits and hospitalization.

Methods: Weather, dates of sporting events, ED visits, hospitalizations, clinic visits, no-shows, and same-day patient cancellations from 2015 to 2018 were abstracted from Milwaukee's Veterans Affairs (VA) medical system.

Results: Inclement precipitation increased clinic cancellations.

Preoperative Thoracic Spine Magnetic Resonance Imaging for Spinal Cord Stimulation: Should Such a Recommendation Be an Absolute Requirement?

Objective: Current published guidelines recommend advanced imaging, specifically, thoracic magnetic resonance imaging (MRI), prior to implantation of epidural paddle spinal cord stimulator (SCS) leads. Preoperative imaging may affect surgical approach to minimize risk of complications. We aimed to assess the impact of preoperative thoracic MRI on surgical planning in a large series of surgical paddle SCS lead placements in a real-world setting.

Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Quality Measures Initiative.

Purpose: Ensuring high quality, evidence-based radiation therapy for patients is of the upmost importance. As a part of the largest integrated health system in America, the Department of Veterans Affairs National Radiation Oncology Program (VA-NROP) established a quality surveillance initiative to address the challenge and necessity of providing the highest quality of care for veterans treated for cancer.

Methods And Materials: As part of this initiative, the VA-NROP contracted with the American Society for Radiation Oncology to commission 5 Blue Ribbon Panels for lung, prostate, rectal, breast, and head and neck cancers experts.

Consensus Quality Measures and Dose Constraints for Head and Neck Cancer with an emphasis on Oropharyngeal and Laryngeal Cancer from the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel.

Purpose: Safeguarding high-quality care using evidence-based radiation therapy for patients with head and neck cancer is crucial to improving oncologic outcomes, including survival and quality of life.

Methods And Materials: The Veterans Administration (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance Program (VAROQS) to develop clinical quality measures (QM) in head and neck cancer. As part of the development of QM, the VA commissioned, along with the American Society for Radiation Oncology, a blue-ribbon panel comprising experts in head and neck cancer, to develop QM.

Characterization of a Red Light-Activated Vasodilation: A Photobiomodulation Study.

Nitric oxide dependent vasodilation is an effective mechanism for restoring blood flow to ischemic tissues. Previously, we established an murine model whereby red light (670 nm) facilitates vasodilation an endothelium derived vasoactive species which contains a functional group that can be reduced to nitric oxide. In the present study we investigated this vasodilator by measuring blood flow with Laser Doppler Perfusion imaging in mice.

Acute and long-term effects of cannabinoids on hypertension and kidney injury.

Cannabinoids and their endogenous and synthetic analogs impact blood pressure and contribute to the incidence of hypertension. It was previously reported that the endocannabinoid system plays an important role in developing hypertension; however, it was also shown that cannabinoids elicit profound hypotension associated with hemorrhagic, cardiogenic, and endotoxic shock. This study aimed to test acute and chronic effects of an endogenous ligand of cannabinoid receptor anandamide (AEA) on blood pressure and kidney injury in vivo in conscious Dahl salt-sensitive (SS) rats.

A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis.

Background: Web-based tools developed to facilitate a shared decision-making (SDM) process may facilitate the implementation of lung cancer screening (LCS), an evidence-based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that affect the benefits and potential harms of LCS and thus may value a veteran-centric LCS decision tool (LCSDecTool).

Objective: This study aims to conduct usability testing of an LCSDecTool designed for veterans receiving care at a Veteran Affairs medical center.

Veteran Engagement in Health Services Research: a Conceptual Model.

With 20 million living veterans and millions more immediate family members, and approximately 9 million veterans enrolled in the nationally networked VA healthcare system, representing the interests and needs of veterans in this complex community is a substantial endeavor. Based on the importance of engaging Veterans in research, the VA Health Services Research and Development (HSR&D) Service convened a Working Group of VA researchers and Veterans to conduct a review of patient engagement models and develop recommendations for an approach to engage Veterans in health research that would incorporate their unique lived experiences and interests, and their perspectives on research priorities. The Working Group considered the specific context for Veteran engagement in research that includes other VA stakeholders from the operational and clinical leadership of the VA Health Administration (VHA).

Lisinopril Mitigates Radiation-Induced Mitochondrial Defects in Rat Heart and Blood Cells.

The genetic bases and disparate responses to radiotherapy are poorly understood, especially for cardiotoxicity resulting from treatment of thoracic tumors. Preclinical animal models such as the Dahl salt-sensitive (SS) rat can serve as a surrogate model for salt-sensitive low renin hypertension, common to African Americans, where aldosterone contributes to hypertension-related alterations of peripheral vascular and renal vascular function. Brown Norway (BN) rats, in comparison, are a normotensive control group, while consomic SSBN6 with substitution of rat chromosome 6 (homologous to human chromosome 14) on an SS background manifests cardioprotection and mitochondrial preservation to SS rats after injury.

Duration of effectiveness of coblation for recurrent epistaxis in hereditary hemorrhagic telangiectasia.

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease leading to recurrent epistaxis, telangiectasias, and/or visceral arteriovenous malformations. Multiple treatment methods, including both pharmacologic and surgical, are described to be effective in managing symptomatic HHT. Few report the duration of symptom improvement for each of these treatment methods.