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Обследование знаний, опыта и качества жизни, связанных с инфекциями мочевого тракта у людей с нейрогеническим мочевым пузырем.

Заражение мочевого тракта (UTI) является обычным осложнением у людей с нейрогеническим мочевым пузырем (NB). Существует ограниченный объем данных о воздействии на эту группу населения знаний, опыта и качества жизни (QoL). МЕТОДЫ: Мы направили опросы 289 ветеранам с NB в связи с повреждением/деформацией спинного мозга (SCI/D), множественным склерозом или болезнью Паркинсона, у которых был диагностирован УТИ в четырех медицинских центрах по делам ветеранов в период с мая 2022 года по май 2023 года. Обследование было адаптировано на основе существующих инструментов и ранее собирало качественные д

Совпадение в аннотации оригинала
BACKGROUND: Urinary tract infections (UTI) are common complications in people with neurogenic bladder (NB). Limited data exist on UTI-related knowledge, experiences, and quality of life (QoL) impacts in this population. METHODS: We mailed surveys to 289 Veterans with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis, or Parkinson's Disease w…

Symptom validity indices for the Beck Depression Inventory-II: Development and cross-validation in research and clinical samples.

Objective: The present study sought to cross validate the recently developed total score cut-off for the Beck Depression Inventory-II (BDI-II) and identify additional embedded symptom validity indices within this commonly used self-report depression measure. Methods: Study 1 included a research sample of 379 veterans with diagnostic subgroups of Current and Lifetime Depression and Current and Lifetime Posttraumatic Stress Disorder (PTSD). Study 2 included a clinical sample of 224 veterans with diagnostic subgroups of Current Depression, Lifetime Depression, and No Depression. Three embedded BD…

Prevalence of neck pain among unilateral upper limb amputees: A systematic review and meta-analysis.

BACKGROUND: Neck pain is a significant health concern for unilateral upper limb amputees (UULAs), affecting their functional status and qual … the North American population, 51% (95% CI: 28-74) in European countries, 28% (95% CI: 11-54) among veterans and 49% (95% CI: 31-67) among the general population. CONCLUSION: Neck pain is common among UULAs; variations are noted across the general population and veterans, as per geography and increased sample size of the population. Physical therapists an …

Sleep as a predictor of improved response to transcranial magnetic stimulation for depression (SPIRiTeD).

BACKGROUND: Transcranial magnetic stimulation (TMS) is an evidence-based approach to treatment- resistant Major Depressive Disorder (TRD). Sleep dysfunction is associated with poor outcomes in TRD, however, the impacts of sleep dysfunction on TMS treatment has yet to be defined. This study examined the association between sleep dysfunction and improvement in depression symptoms with TMS treatment for TRD. METHODS: A retrospective observational cohort study was conducted examining all Veterans receiving TMS treatments through the "VA TMS Clinical Pilot Program" over a three-year period. The Pa…

Early detection of liver disease in patients with alcohol use disorder improves long-term abstinence.

AIMS: Excessive alcohol consumption is a major global health concern, contributing to millions of deaths annually and a significant proportion of cirrhosis cases; however, standardized protocols for early identification of alcohol-associated liver disease are lacking. In this retrospective cohort study, we aimed to understand the prevalence and risk factors associated with elevated liver stiffness measurement (LSM) in high-risk patients with alcohol use disorder (AUD) and identify variables associated with longitudinal abstinence and outcomes. METHODS: Veterans with severe AUD without known l…

Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV.

Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008-2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring…

Neoadjuvant Arterial Embolization of Spine Metastases Associated With Improved Local Control in Patients Receiving Surgical Decompression and Stereotactic Body Radiotherapy.

BACKGROUND: Spine metastases often cause significant pain, instability, and/or neurological morbidity. Local control (LC) of spine metastase … nformation, radiographic studies, treatment characteristics, Karnofsky Performance Score, Defensive Veterans Pain Rating Scale, and mean daily doses of analgesic medications were reviewed. LC was assessed using magnetic resonance imaging obtained at a median 3-month interval and defined as progression at the surgically treated vertebral level. RESULTS: Of …

Care Practices of Mental Health Clinical Pharmacist Practitioners Within an Interdisciplinary Primary Care Model for Patients With Substance Use Disorders.

BACKGROUND: Clinical pharmacist practitioners (CPPs) play an increasingly important role in interdisciplinary care for patients with substance use disorders (SUDs). However, CPPs' scope of practice varies substantially across clinics and settings. OBJECTIVES: We sought to describe CPP practices and activities within an interdisciplinary, team-based primary care clinic dedicated to treat Veterans with histories of substance use disorders, experience of homelessness, high medical complexity, and other vulnerabilities. METHODS: We conducted a retrospective cohort study of CPP activities using D…

Self-reported Fatigue was Associated with Increased White-matter Alterations in Long-term Traumatic Brain Injury and Posttraumatic Stress Disorder Patients.

Fatigue is a long-lasting problem in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), with limited research that investigated the fatigue-related white-matter changes within TBI and/or PTSD cohorts. This exploratory cross-sectional study used diffusion tensor imaging (DTI) and neuropsychological data collected from 153 male Vietnam War veterans, as part of the Alzheimer's Disease Neuroimaging Initiative - Department of Defense, and were divided clinically into control veterans, PTSD, TBI, and with both TBI and PTSD (TBI + PTSD). The existence of fatigue was defined by th…

Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period: The Impact of Structure and Processes of Care.

BACKGROUND: Few performance measures assess presurgical value (quality and utilization). OBJECTIVES: Using carpal tunnel syndrome (CTS) as a case study: (1) develop a model to evaluate presurgical quality and utilization and (2) identify opportunities for value improvement. RESEARCH DESIGN: A retrospective cohort study utilizing Veterans Affairs (VA) national administrative data. SUBJECTS: Patients who were evaluated in a VA primary care clinic on at least 1 occasion for CTS and received carpal tunnel release over a 7-year period. MEASURES: We modeled facility-level performance on 2 outcom…

The Heart and Cannabis (THC) Cohort: Differences in Baseline Health and Behaviors by Cannabis Use.

BACKGROUND: Evidence on the cardiovascular health effects of cannabis use is limited. We designed a prospective cohort study of older Veterans (66 to 68 years) with coronary artery disease (CAD) to understand the cardiovascular consequences of cannabis use. We describe the cohort construction, baseline characteristics, and health behaviors that were associated with smoking cannabis. OBJECTIVE: To understand the cardiovascular consequences of cannabis use. DESIGN: We designed a prospective cohort study of older Veterans (66 to 68 years) with CAD. PARTICIPANTS: A total of 1,015 current cannab…

Cessation of self-reported opioid use and impacts on co-occurring health conditions.

BACKGROUND: Among veterans in care reporting opioid use, we investigated the association between ceasing opioid use on subsequent reduction in report of other substance use and improvements in pain, anxiety, and depression. METHODS: Using Veterans Aging Cohort Study survey data collected between 2003 and 2012, we emulated a hypothetical randomized trial (target trial) of ceasing self-reported use of prescription opioids and/or heroin, and outcomes including unhealthy alcohol use, smoking, cannabis use, cocaine use, pain, and anxiety and depressive symptoms. Among those with baseline opioid us…

Risk of volume depletion events with concomitant use of sodium glucose co-transporter 2 inhibitors and loop diuretics: A self-controlled case series study.

BACKGROUND: Sodium glucose co-transporter 2 inhibitors (SGLT2is) are used to prevent cardiovascular complications in type 2 diabetes mellitus (T2DM) and newly indicated to treat heart failure (HF). Loop diuretics are commonly prescribed to manage volume overload in HF and may increase the risk of volume depletion in real-world practice. This study evaluated the risk of volume depletion following concomitant use of SGLT2is and loop diuretics in veterans. METHODS: Veterans with T2DM were included if they received concomitant loop diuretics and SGLT2is and experienced at least one volume depleti…

Demographics, clinical characteristics, and prognostic factors of amyotrophic lateral sclerosis in Midwest.

INTRODUCTION/AIMS: The Midwest has the highest regional prevalence of self-reported amyotrophic lateral sclerosis (ALS) in the United States … ALS-Association registered clinics were more frequently male, had familial onset and tracheostomy. Veterans (N = 298) were older at diagnosis but had similar survival after adjustment for age. DISCUSSIONS: Our cohort had an older age at onset and more frequent bulbar onset than the National ALS Registry, perhaps reflecting ascertainment biases in each re …

Association between spatial working memory and Re-experiencing symptoms in PTSD.

BACKGROUND AND OBJECTIVES: Few studies have evaluated the link between working memory (WM) and post-traumatic stress disorder (PTSD). Further, it is unknown whether this relationship is accounted for by other relevant variables including negative affect, emotional dysregulation, or general non-WM-related cognitive control deficits, which are associated with PTSD. The purpose of this study was to determine the extent to which a computerized WM task could predict PTSD symptomology incrementally beyond the contribution of other relevant variables associated with PTSD. METHODS: Thirty veterans we…

Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions.

OBJECTIVE: Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS: We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Af…

Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine: Preliminary Report from a Randomized Clinical Trial.

OBJECTIVE: We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery. DESIGN: Prospective, parallel-arms, randomized, double-blind trial. SETTING: A single veterans' hospital. SUBJECTS: Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic. METHODS: Participants underwent nerve/plexus blocks at L2-L4 and L4-S3 in advance of hip or knee joint replacement surgery. Patients were randomized to rece…

Trajectories of Self-Reported Opioid Use Among Patients With HIV Engaged in Care: Results From a National Cohort Study.

BACKGROUND: No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care. SETTING: Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at 8 US Veterans Health Administration (VA) sites. METHODS: Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported "prescription painkillers" and/or heroin use at baseline and follow-up. We use…

Limb loss in individuals with chronic spinal cord injury.

Objective: The purpose of this study is to describe a population of individuals with chronic spinal cord injury (SCI), who underwent lower limb amputations, identify indications for amputations, medical co-morbidities and summarize resulting complications and functional changes.Design: Retrospective observational cohort study.Setting: SCI Service, Department of Veterans Affairs (VA) Health Care System.Participants: Veterans with SCI of greater than one-year duration who underwent amputation at a VA Medical Center over a 15-year period, using patient registry and electronic health records. Diag…

Adaptive Identification of Cortical and Subcortical Imaging Markers of Early Life Stress and Posttraumatic Stress Disorder.

BACKGROUND AND PURPOSE: Posttraumatic stress disorder (PTSD) is a heterogeneous condition associated with a range of brain imaging abnormalities. Early life stress (ELS) contributes to this heterogeneity, but we do not know how a history of ELS influences traditionally defined brain signatures of PTSD. Here, we used a novel machine learning method - evolving partitions to improve classification (EPIC) - to identify shared and unique structural neuroimaging markers of ELS and PTSD in 97 combat-exposed military veterans. METHODS: We used EPIC with repeated cross-validation (CV) to determine how…