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Quality-of-life changes and hearing impairment. A randomized trial.

OBJECTIVE: To assess whether hearing aids improve the quality of life of elderly persons with hearing loss. SETTING: Primary care clinics at a Bureau of Veterans Affairs hospital. PATIENTS: One hundred and ninety-four elderly veterans who were identified as being hearing impaired from a screening survey involving 771 consecutive clinic patients. Of the original 194, 188 (97%) completed the trial. INTERVENTION: Subjects were randomly assigned to either receive a hearing aid (n = 95) or join a waiting list (n = 99). MAIN ENDPOINTS: A comprehensive battery of disease-specific and generic quali…

Machine learning predicts major adverse kidney and cardiovascular events in heart failure with reduced ejection fraction.

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) links to adverse kidney and cardiovascular events. However, current machine learning (ML)-based algorithms do not include comprehensive echocardiographic features or predict adverse kidney outcomes. METHODS: We built ML models to predict 3-year all-cause mortality, major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE) in retrospective HFrEF cohorts. Models were developed from 1,486 patients at Taipei Veterans General Hospital during 2011-2018 and externally validated in 246 patients from the heart-fa…

Non-small Cell Lung Cancer with and without Spread Through Air Spaces: Which Therapies are Associated with Improved Survival?

BACKGROUND: Spread through air spaces (STAS), defined as tumor cells within alveolar spaces beyond the main tumor, is associated with adverse outcomes in non-small cell lung cancer (NSCLC), but optimal management remains unclear. We evaluated whether extent of resection or adjuvant therapy was associated with improved survival in STAS-positive NSCLC. METHODS: We conducted a retrospective cohort study of Veterans who underwent curative-intent resection for clinical stage I NSCLC within the Veterans Affairs (1/2018-3/2024). Overall survival (OS) and disease-free survival (DFS) were evaluated. P…

The VA HEARS Model for Predicting Audiogram Changes in Adults Undergoing Cisplatin Chemoradiotherapy.

OBJECTIVE: Develop and validate a model for predicting complete audiograms of individual patients that also supports cisplatin-ototoxicity forecasting and early identification using any existing diagnostic and classification criteria. STUDY DESIGN: Prospective observational study. SETTING: Veterans Administration hospital cancer ambulatory care. PATIENTS: One hundred thirty-one Veterans undergoing cisplatin chemotherapy or chemoradiation. MAIN OUTCOME MEASURES: Predicted 0.5 to 8 kHz audiogram thresholds in both ears. Hearing changes were derived from the predicted audiograms using America…

Differences in buprenorphine initiation and retention for opioid use disorder between primary care and substance use disorder specialty care settings.

INTRODUCTION: Buprenorphine, an evidenced-based medication for opioid use disorder (OUD), can be prescribed in any medical setting, including primary care (PC) and substance use disorder (SUD) specialty clinics. While research has identified patient characteristics associated with buprenorphine initiation and retention within both settings, between-settings evaluations have been limited. This evaluation examined differences in patient characteristics associated with buprenorphine initiation and retention between PC and SUD settings within the Veterans Health Administration. METHODS: Retrospec…

Effect of MRI and site variation on surgical treatment for prostate cancer.

BACKGROUND: Increased utilization of prostate magnetic resonance imaging (MRI) over the past decade may have led to a system shift in the patient population selected for radical prostatectomy (RP). We evaluated whether the initial use of MRI before biopsy resulted in the selection of lower-risk patients for RP. MATERIALS AND METHODS: We evaluated patients undergoing RP in the Veterans Health Administration from 2014 to 2024. We compared patients receiving MRI-informed initial biopsy to those who had initial biopsy without MRI. For the primary analysis, multivariable mixed-effects ordinal regr…

Association Between Traumatic Brain Injury (TBI)-Related Clinical Burden and Posttraumatic Stress Disorder Symptom Severity Among Special Operations Forces (SOF): Cross-sectional and Longitudinal Inferences.

OBJECTIVES: To examine how traumatic brain injury (TBI)-related clinical burden (eg, neurobehavioral symptoms, TBI-related lifestyle/participation deficits) is associated with posttraumatic stress disorder (PTSD) symptom trajectories during inpatient rehabilitation. DESIGN: Cross-sectional and longitudinal cohort study. SETTING: Veterans Health Administration Intensive Evaluation and Treatment Program for TBI distributed across 5 sites in the United States. PARTICIPANTS: Participants were male Special Operations Forces with an average age of 42 years (SD, 5.4) and a history of mild to moder…

Alpha-1 Antitrypsin Deficiency in Patients With Cirrhosis in a US National Cohort.

INTRODUCTION: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that increases susceptibility to chronic lung and liver diseases. There are limited data on testing rates in patients with cirrhosis. Guidelines recommend AATD testing in cryptogenic liver disease but not in patients with an established etiology. We aimed to quantify AATD testing patterns in a national cohort of patients with cirrhosis to inform guidelines. METHODS: In this retrospective cohort study of veterans with a new diagnosis of cirrhosis between January 1, 2008 and January 31, 2020, with follow-up until Februar…

Присутствие и воздействие усталости у пациентов с множественным склерозом.

Усталость часто встречается в множестве склерозов (MS) и отрицательно сказывается на функционировании и качестве жизни. Мы изучили клинические корреляции усталости, ее связь с депрессией и сонливостью, а также вопрос о том, улучшают ли лекарственные препараты, связанные с усталостью, результаты, о которых сообщают пациенты. В. МАТЕРИАЛЫ И МЕТОДЫ 203 Ветераны, классифицируемые по признаку наличия или отсутствия усталости. Первичными результатами были изменения в шкале усталости (СФС), изменённой шкале воздействия на усталость (MFIS) и шкале сна Epworth (ESS) от базового уровня до базового уровн

Совпадение в аннотации оригинала
BACKGROUND Fatigue is common in multiple sclerosis (MS) and adversely affects function and quality of life. We examined clinical correlates … er, longitudinal observational study retrospectively analyzed prospectively collected data from 203 veterans, categorized based on the presence or absence of fatigue. Primary outcomes were changes in the Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), and Epworth Sleepiness Scale (ESS) from baseline to 12 months. Secondary outcomes incl …

Caregiving Network Characteristics and Mental Health Care Utilization by Older Adults.

BACKGROUND: Rates of mental health service use are low among older adults. This study examined associations between mental health care utilization and caregiving network characteristics, including caregiving network size, caregiving intensity, the presence of formal helpers, and primary caregiver characteristics. METHODS: Using a sample of 692 respondents in the health and retirement study (HRS) with linkage to veterans affairs healthcare records (mean age = 78.7, SD = 8.08; 97.1% male), logistic regression models tested caregiving network characteristics as predictors of mental health care u…

Longitudinal network structures in PTSD treatment outcomes: Implications for tailored treatment.

Post-traumatic Stress Disorder (PTSD) is a debilitating condition disproportionately affecting military populations. Despite wide-spread availability of trauma-focused treatments like Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), many patients continue to experience PTSD symptoms post-treatment. This study employed network analyses to investigate variations in PTSD symptom networks between treatment responders and non-responders. The sample comprised 1902 service members and veterans who completed a two-week intensive PTSD treatment program (CPT or PE). The PTSD Check…

Association of acamprosate versus gabapentinoids with hospitalization and total mortality in alcohol use disorder.

IMPORTANCE: Alcohol use disorder (AUD) significantly increases hospitalizations and death. US Food and Drug Administration (FDA)-approved medications for AUD are underutilized. Gabapentinoids are not FDA-approved for AUD but are frequently prescribed by physicians. OBJECTIVE: To examine the association of acamprosate and gabapentinoids on healthcare utilization and total mortality in patients with AUD. METHODS: Two propensity score (PS)-matched retrospective cohort studies. PARTICIPANTS: Veterans diagnosed with AUD (years 2003-2021) initiating acamprosate or gabapentinoids in an AUD-related…

Serotonin 5-HT2A receptor expression is chronically decreased in the anterior cerebral cortex of male rats following repetitive low-level blast exposure.

INTRODUCTION: Many Veterans who experienced blast-related traumatic brain injuries (TBIs) in Iraq and Afghanistan currently suffer from chronic cognitive and mental health problems that include depression and post-traumatic stress disorder (PTSD). Male rats exposed to repetitive low-level blast develop chronic cognitive and PTSD-related behavioral traits that are present for more than 1 year after exposure. Psychedelic agents alter cognition as well as mood and agents such as psilocybin have gained attention as possible treatments for the mental health disorders that affect Veterans. The best-…

Pain when it "counts": hurdle analysis of clinical pain ratings improves data model performance.

OBJECTIVES: The Numerical Rating Scale is widely used for patient-reported appraisals of pain intensity; however, scale properties have limited utility for assessing chronic pain. Specifically, single pain ratings demonstrate high intraindividual variability. We propose an efficient alternative, termed hurdle analysis, separately analyzing zero and nonzero pain ratings. METHODS: This retrospective study of 23,480 US Veterans diagnosed with low back pain (LBP) included 2.1 million unique pain ratings. Marginal distributions comprised of all pain ratings for each individual were parametrized wi…

Evaluation of umbilical cord blood serum eye drops for severe dry eye in two distinct populations-Sjögren's syndrome and mustard gas-induced ocular injury: Protocol for a pilot randomized clinical trial.

BACKGROUND: Human umbilical cord blood (HUCB) serum eye drops contain growth factors, neurotrophic agents, and antimicrobial compounds that may promote ocular surface healing and regeneration. Sjögren's syndrome is a chronic autoimmune condition characterized by reduced tear production and ocular surface damage, often resulting in severe dry eye symptoms. Mustard gas chemical veterans also suffer from similar debilitating ocular complications due to chronic inflammation and meibomian gland dysfunction. While conventional treatments offer symptomatic relief, they lack essential components of na…

Goal-Oriented Attentional Self-Regulation Training in Chronic Mild Traumatic Brain Injury is Linked to Microstructural Plasticity in Prefrontal White Matter.

Impaired attention is one of the most common, debilitating, and persistent consequences of traumatic brain injury (TBI), which impacts overa … stigated the effect of GOALS training on prefrontal white matter microstructure in 19 U.S. military veterans with chronic mTBI, compared with a matched control group of 14 veterans with chronic mTBI who received standard of care brain health education. We also tested for an association between microstructural white matter changes and sustained attention ab …

Naltrexone augmented with prazosin for alcohol use disorder: results from a randomized controlled proof-of-concept trial.

AIMS: We conducted a proof-of-concept randomized controlled trial of the mu-opioid receptor antagonist, naltrexone, augmented with the alpha-1 adrenergic receptor antagonist, prazosin, for alcohol use disorder in veterans. We sought a signal that the naltrexone plus prazosin combination regimen would be superior to naltrexone alone. METHODS: Thirty-one actively drinking veterans with alcohol use disorder were randomized 1:1:1:1 to naltrexone plus prazosin (NAL-PRAZ [n = 8]), naltrexone plus placebo (NAL-PLAC [n = 7]), prazosin plus placebo (PRAZ-PLAC [n = 7]), or placebo plus placebo (PLAC-PL…

The Association of Organizational Readiness With Lung Cancer Screening Utilization.

INTRODUCTION: Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. METHODS: Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear re…

(2R,6R)-Hydroxynorketamine Treatment of Rats Exposed to Repetitive Low-Level Blast Injury.

Many military veterans who experienced blast-related traumatic brain injuries (TBIs) in the conflicts in Iraq and Afghanistan suffer from chronic cognitive and mental health problems, including post-traumatic stress disorder (PTSD). Male rats subjected to repetitive low-level blast exposure develop chronic cognitive and PTSD-related traits that develop in a delayed manner. Ketamine has received attention as a treatment for refractory depression and PTSD. (2R,6R)-hydroxynorketamine [(2R,6R)-HNK] is a ketamine metabolite that exerts rapid antidepressant actions. (2R,6R)-HNK has become of clinica…

Ankle- and Toe-Brachial Index for Peripheral Artery Disease Identification: Unlocking Clinical Data Through Novel Methods.

BACKGROUND: Despite its high prevalence and clinical impact, research on peripheral artery disease (PAD) remains limited due to poor accuracy of billing codes. Ankle-brachial index (ABI) and toe-brachial index can be used to identify PAD patients with high accuracy within electronic health records. METHODS: We developed a novel natural language processing (NLP) algorithm for extracting ABI and toe-brachial index values and laterality (right or left) from ABI reports. A random sample of 800 reports from 94 Veterans Affairs facilities during 2015 to 2017 was selected and annotated by clinical e…