Article
Rehabilitation
Marc A. Silva, Shannon R. Miles, Therese M. O'Neil-Pirozzi, David B. Arciniegas, Farina Klocksieben, Clara E. Dismuke-Greer, William C. Walker, Risa Nakase-Richardson
Summary: This study aimed to explore the factor structure of the Rehabilitation Needs Survey (RNS) by conducting a secondary analysis of an observational cohort study on individuals who were 5 years post-traumatic brain injury (TBI). The results showed that the RNS factor structure could be explained by exploratory factor analysis (EFA), and a 2-factor solution with satisfactory internal consistency was chosen as the most concise and clinically applicable model. Additionally, the RNS structure corresponded with elements of the International Classification of Functioning, Disability and Health (ICF) conceptual framework.
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
(2023)
Article
Rehabilitation
Bridget A. Cotner, Risa Nakase-Richardson, Danielle R. O'Connor, Marc A. Silva, Flora M. Hammond, Noelle E. Carlozzi, Jacob A. Finn, Joyce Chung, Jeanne M. Hoffman
Summary: This study aimed to compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. The results showed that ease of communication, family support, government and community facilities, and online resources were the main facilitators, while distance to services was the main barrier. The barriers and facilitators varied by TBI severity, highlighting the need for tailored approaches.
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
(2023)
Article
Rehabilitation
Marc A. Silva, Alicia B. VandenBussche Jantz, Farina Klocksieben, Kimberley R. Monden, Amanda R. Rabinowitz, Bridget A. Cotner, Christina Dillahunt-Aspillaga, Risa Nakase-Richardson
Summary: The study identified factors associated with life satisfaction after traumatic brain injury, including employment status, participation, and depression, with unmet rehabilitation needs having an indirect impact on life satisfaction.
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
(2021)
Article
Rehabilitation
Marc A. Silva, Jacob A. Finn, Christina Dillahunt-Aspillaga, Bridget A. Cotner, Lillian F. Stevens, Risa Nakase-Richardson
Summary: The Rehabilitation Needs Survey (RNS) was developed through expert consensus and was administered to TBI patients in the chronic phase. The RNS identified an average of 8-9 endorsed needs and 1-2 unmet needs. Correlations were found between number of needs endorsed and functional status, neurobehavioral symptoms, and mental health symptoms, supporting the convergent validity of the RNS. Further research on the psychometrics and clinical utility of the RNS is recommended.
DISABILITY AND REHABILITATION
(2022)
Article
Health Care Sciences & Services
Warren B. P. Pettey, Todd H. Wagner, Amy K. Rosen, Erin Beilstein-Wedel, Michael Shwartz, Megan E. Vanneman
Summary: The study found that although many veterans drove farther than needed to get cataract surgery in CC, this was not true for obtaining care in the VA. Our findings suggest that there may be additional reasons, besides driving distance, that affect whether Veterans choose CC and, if they do, where they seek CC.
Article
Public, Environmental & Occupational Health
Claudia Der-Martirosian, William Neil Steers, Heather Northcraft, Karen Chu, Aram Dobalian
Summary: With the surge of the COVID-19 Omicron variant in the U.S., there is a need for more research on increasing vaccination rates. This study examines the characteristics of veterans who were vaccinated and identifies groups that are less likely to get vaccinated, providing insights for targeted interventions.
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
(2022)
Article
Obstetrics & Gynecology
Deirdre A. Quinn, Maria K. Mor, Florentina E. Sileanu, Xinhua Zhao, Lisa S. Callegari, Laurie C. Zephyrin, Daniel J. Frayne, Sonya Borrero
Summary: The study assessed the feasibility of using preconception health measures in a large healthcare system and found issues such as inadequate prenatal care, high obesity rates, and high rates of smoking and depression among female veterans.
OBSTETRICS AND GYNECOLOGY
(2021)
Article
Health Care Sciences & Services
Kate L. Sheahan, Karen M. Goldstein, Claire T. Than, Bevanne Bean-Mayberry, Catherine C. Chanfreau, Megan R. Gerber, Danielle E. Rose, Julian Brunner, Ismelda A. Canelo, Jill E. Darling Mshs, Sally Haskell, Alison B. Hamilton, Elizabeth M. Yano
Summary: The study surveyed 1,391 women Veterans who routinely use VA primary care, finding that they have significant multimorbid physical and mental health conditions and trauma histories, requiring continued investment in woman-centered primary care and emphasis on trauma-informed, age-specific care.
JOURNAL OF GENERAL INTERNAL MEDICINE
(2022)
Article
Neurosciences
Janette A. A. Hamilton, Jessica M. M. Ketchum, Flora M. M. Hammond, Michelle D. D. Peterson, Nathan D. D. Zasler, Blessen C. C. Eapen, Maheen Mausoof Adamson, Pawan P. P. Galhorta, Odette Harris, Risa Nakase-Richardson
Summary: This study compares the outcomes of veterans and civilians with severe TBI and finds that veterans are more likely to be re-hospitalized or reside in long-term care or rehab settings after rehabilitation. However, civilians show more significant improvements in cognitive function at discharge.
Article
Rehabilitation
Andrea Crunkhorn, Erin Andrews, Christopher Fantini, M. Jason Highsmith, Megan Loftsgaarden, Billie Randolph, James Sall, Joseph Webster
Summary: Upper limb amputation can cause functional impairment and the need for comprehensive rehabilitation. In 2022, the Department of Veteran Affairs and Defense published an updated clinical practice guideline for upper limb amputation rehabilitation. The guideline was developed by a workgroup of subject-matter experts and includes 18 recommendations based on extensive literature review and evaluation. Four of the recommendations have sufficient evidence supporting the use of specific rehabilitation strategies. However, the lack of high-quality evidence limits evidence-based clinical guidance for healthcare providers.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION
(2023)
Article
Medicine, General & Internal
Nada Andelic, Cecilie Roe, Olli Tenovuo, Philippe Azouvi, Helen Dawes, Marek Majdan, Jukka Ranta, Emilie I. Howe, Eveline J. A. Wiegers, Cathrine Tverdal, Ida Borgen, Marit V. Forslund, Ingerid Kleffelgaard, Hilde M. Dahl, Louis Jacob, Melanie Cogne, Juan Lu, Nicole von Steinbuechel, Marina Zeldovich
Summary: This study aimed to assess rehabilitation needs and services for individuals with moderate-to-severe disability after traumatic brain injury. The study found that severity of brain injury, physical and cognitive impairments increased the likelihood of receiving rehabilitation, while psychological problems decreased it.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Education, Scientific Disciplines
Kathleen A. Klink, Anthony P. Albanese, Edward T. Bope, Karen M. Sanders
Summary: Despite a well-trained and specialized physician workforce, the United States still faces healthcare gaps nationwide. The expansion of physician GME training in the Veterans Health Administration has proven successful in addressing physician shortages and could serve as a model for addressing national physician specialty and geographic workforce needs.
Review
Surgery
Mariah Blegen, Jamie Ko, Garrett Salzman, Meron M. Begashaw, Jesus G. Ulloa, Mark Girgis, Paul Shekelle, Melinda Maggard-Gibbons
Summary: In response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the MISSION Act of 2018 to create a program for patients to receive care in non-VA sites of care, paid by VA. A review of recent evidence comparing surgical care between VA and non-VA delivered care found that VA surgical care has similar or better quality and safety outcomes compared to non-VA sites of care, but non-VA care shows better cost/efficiency outcomes. The expansion of eligibility for veterans to receive care in the community may not increase access to surgical procedures or improve quality, but it may lead to shorter inpatient stays and potentially lower costs.
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
(2023)
Letter
Medicine, General & Internal
Andrew J. Read, Akbar K. Waljee, Charity S. Chen, Robert Holleman, Kyle E. Kumbier, Sameer D. Saini
Summary: This cohort study examines the prevalence of appropriate testing for incident anemia in a large cohort from a national integrated health care system.
Article
Psychiatry
Mark Weiser, John M. Davis, Clayton H. Brown, Eric P. Slade, Li Juan Fang, Deborah R. Medoff, Robert W. Buchanan, Linda Levi, Michael Davidson, Julie Kreyenbuhl
Summary: The study compared the clinical effectiveness of oral and long-acting injectable antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs health care system. Results indicated that clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy were associated with longer maintenance of the same antipsychotic therapy compared to the reference drug, oral olanzapine.
AMERICAN JOURNAL OF PSYCHIATRY
(2021)
Article
Substance Abuse
Viengneesee Thao, John A. Nyman, David B. Nelson, Anne M. Joseph, Barbara Clothier, Patrick J. Hammett, Steven S. Fu
Article
Health Care Sciences & Services
Wei Duan-Porter, David B. Nelson, Kristine E. Ensrud, Michele R. Spoont
Summary: This study using data from a national cohort of veterans in VA care found that greater limitations in physical functioning may act as barriers to initiating and retaining psychotherapy for individuals with PTSD, but had no significant effect on the initiation of medications.
BMC HEALTH SERVICES RESEARCH
(2021)
Article
Psychology, Clinical
Nina A. Sayer, Shannon Wiltsey-Stirman, Craig S. Rosen, Nancy C. Bernardy, Michele R. Spoont, Shannon M. Kehle-Forbes, Afsoon Eftekhari, Kathleen M. Chard, David B. Nelson
Summary: The study investigated whether VHA therapists have different levels of success in keeping PTSD patients engaged in evidence-based psychotherapies. Therapist effects were found to influence patient treatment experience and outcomes, with therapist skills and work environment contributing to variability in early dropout and adequate dose. Therapists in the highest retention decile were associated with higher odds of patients receiving an adequate dose compared to therapists in the lowest retention decile.
JOURNAL OF TRAUMATIC STRESS
(2022)
Article
Health Care Sciences & Services
Jasvinder A. Singh, David B. Nelson, Kristin L. Nichol
Summary: Changes in the mental health component were weakly associated with mortality outcomes, but not significantly correlated with hospitalization. Patient's current HRQOL generally provides meaningful information for predicting subsequent mortality and hospitalization.
JOURNAL OF CLINICAL EPIDEMIOLOGY
(2021)
Article
Psychology, Clinical
Michele Spoont, David Nelson, Shannon Kehle-Forbes, Laura Meis, Maureen Murdoch, Craig Rosen, Nina Sayer
Summary: The study evaluated variations in clinical outcomes across different racial and ethnic groups of veterans diagnosed with PTSD in VHA, finding disparities in PTSD and mental health quality of life outcomes for some racial and ethnic minority groups of veterans. However, in this study, improvements in PTSD symptoms and mental health quality of life were interrelated in complex ways across groups.
PSYCHOLOGICAL SERVICES
(2021)
Article
Medicine, Research & Experimental
Laura A. Meis, Shirley M. Glynn, Michele R. Spoont, Shannon M. Kehle-Forbes, David Nelson, Carl E. Isenhart, Afsoon Eftekhari, Princess E. Ackland, Erin B. Linden, Robert J. Orazem, Andrea Cutting, Emily M. Hagel Campbell, Millie C. Astin, Katherine E. Porter, Erin Smith, Christopher D. Chuick, Kristen E. Lamp, Tessa C. Vuper, Taylor A. Oakley, Lila B. Khan, Sally K. Keckeisen, Melissa A. Polusny
Summary: This paper describes a research method to evaluate whether family inclusion in Prolonged Exposure can improve treatment adherence for posttraumatic stress disorder. The results will provide important evidence for best practices in family involvement in trauma-focused treatments.
Article
Medicine, Research & Experimental
Shannon M. Kehle-Forbes, David Nelson, Sonya B. Norman, Paula P. Schnurr, M. Tracie Shea, Princess E. Ackland, Laura Meis, Kyle Possemato, Melissa A. Polusny, David Oslin, Jessica L. Hamblen, Tara Galovski, Marie Kenny, Nofisat Babajide, Hildi Hagedorn
Summary: This study aims to compare the effectiveness of trauma-focused therapy (TFT) and non-trauma-focused therapy (NTFT) for Veterans with PTSD and SUD. The study will examine the impact of varying SUD severity, type of substances used, and patient treatment preference.
CONTEMPORARY CLINICAL TRIALS
(2022)
Article
Medicine, Research & Experimental
Erin E. Krebs, William C. Becker, David Nelson, Beth M. DeRonne, Sean Nugent, Agnes C. Jensen, Erin C. Amundson, Jennifer K. Manuel, Brian Borsari, Allyson M. Kats, Karen H. Seal
Summary: The Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study is a 12-month trial conducted at ten United States Veterans Affairs (VA) health care sites, aiming to test interventions to improve pain while reducing opioid use among VA patients. The study faced challenges from opioid prescribing trends and the COVID-19 pandemic but successfully recruited eligible patients. The results will provide limited evidence for interventions to improve pain and reduce opioid use.
CONTEMPORARY CLINICAL TRIALS
(2023)
Article
Clinical Neurology
Craig S. Rosen, Adam N. Kaplan, David B. Nelson, Heidi La Bash, Kathleen M. Chard, Afsoon Eftekhari, Shannon Kehle-Forbes, Shannon Wiltsey Stirman, Nina A. Sayer
Summary: This study assessed longitudinal changes in burnout among psychotherapists before and during the COVID-19 pandemic. It found that burnout prevalence increased during the pandemic and organizational support for evidence-based psychotherapies reduced burnout risk prior to the pandemic.
JOURNAL OF AFFECTIVE DISORDERS
(2023)
Article
Public, Environmental & Occupational Health
Shannon Wiltsey Stirman, Heidi La Bash, David Nelson, Robert Orazem, Abigail Klein, Nina A. Sayer
Summary: This paper describes the strategies used by the US Department of Veterans Affairs (VA) to understand adherence and modifications to evidence-based psychotherapies (EBPs) for Posttraumatic Stress Disorder (PTSD) using clinical documentation and administrative data. The study found that a combination of manual chart review and administrative data allowed for the identification of different types of modifications, and that therapists and patients contributed to the variance in modifications. However, scalable strategies are needed to document adaptations and modifications to EBPs in routine care.
FRONTIERS IN PUBLIC HEALTH
(2022)
Article
Medicine, General & Internal
Arianne K. Baldomero, Ken M. Kunisaki, Chris H. Wendt, Ann Bangerter, Susan J. Diem, Kristine E. Ensrud, David B. Nelson, Carrie Henning-Smith, Bradley A. Bart, Patrick Hammett, Hildi J. Hagedorn, R. Adams Dudley
Summary: This study used data from the National Veterans Health Administration and Medicare to assess the impact of drive time on the receipt of guideline-recommended screening, diagnosis, and treatment interventions. The study found that longer drive time was associated with lower rates of receiving recommended services.
Article
Mathematical & Computational Biology
Adam Kaplan, David Nelson
Summary: Missing outcomes are common in randomized controlled trials (RCTs) and can introduce bias in the analysis. We focus on binary outcomes that are possibly missing not at random. Anticipated response rates can be used to address these missing outcomes, especially when considering successful and unsuccessful treatment outcomes. We present Bayesian pattern-mixture models that incorporate information on response rates to analyze the relationship between a binary outcome and an intervention.
STATISTICS IN MEDICINE
(2023)
Article
Substance Abuse
Steven S. Fu, Dave Nelson, Tam Do, Diana J. Burgess, Christi A. Patten, Shu-Hong Zhu, Brian C. Martinson
Summary: This pilot study assessed the feasibility of two proactive outreach interventions to connect Vietnamese-speaking participants who smoke to the ASQ. The results showed that both proactive telephone outreach with interactive voice response (PRO-IVR) and proactive telephone outreach with a counselor trained in motivational interviewing (PRO-MI) were successful in promoting the initiation of smoking cessation treatment with the ASQ.
NICOTINE & TOBACCO RESEARCH
(2023)
Article
Respiratory System
Anne C. Melzer, Hildi Hagedorn, David Nelson, Adam Kaplan, Megan Campbell, Steven S. Fu
Summary: Despite overall increase in use, certain patient populations have persistently low technology use. This study examined access to, use of, and barriers surrounding information and communication technology (ICT) among patients with chronic obstructive pulmonary disease (COPD) who smoke, and evaluated associations between key predictors and electronic health (e-health) literacy. The findings indicate that many COPD patients face barriers to engagement with health promotion programs offered electronically, which may contribute to health disparities. Health promotion programs must address the low use of ICT and e-health literacy to ensure equitable access.
ANNALS OF THE AMERICAN THORACIC SOCIETY
(2023)
Article
Psychology, Clinical
Patrick J. Hammett, Harry A. Lando, Darin J. Erickson, Rachel Widome, Brent C. Taylor, David Nelson, Sandra J. Japuntich, Steven S. Fu
JOURNAL OF BEHAVIORAL MEDICINE
(2020)