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[PMID]:28459897
[Au] Autor:Graber CJ; Jones MM; Chou AF; Zhang Y; Goetz MB; Madaras-Kelly K; Samore MH; Glassman PA
[Ad] Endereço:Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine at the University of California, Los Angeles, CA.
[Ti] Título:Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers.
[So] Source:J Hosp Med;12(5):301-309, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. OBJECTIVE: To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. DESIGN: In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage. SETTING: All 130 VA facilities with acute care services. RESULTS: Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders. CONCLUSIONS: Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309.
[Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico
Gestão de Antimicrobianos/normas
Revisão de Uso de Medicamentos/normas
Hospitalização
Hospitais de Veteranos/normas
United States Department of Veterans Affairs/normas
[Mh] Termos MeSH secundário: Gestão de Antimicrobianos/métodos
Revisão de Uso de Medicamentos/métodos
Hospitalização/tendências
Seres Humanos
Serviço de Farmácia Hospitalar/métodos
Serviço de Farmácia Hospitalar/normas
Inquéritos e Questionários
Estados Unidos/epidemiologia
Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2730


  2 / 6161 MEDLINE  
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[PMID]:29480838
[Au] Autor:Cheng Y; Nickman NA; Jamjian C; Stevens V; Zhang Y; Sauer B; LaFleur J
[Ad] Endereço:Biomedical Informatics Center, George Washington University, Washington, DC.
[Ti] Título:Predicting poor adherence to antiretroviral therapy among treatment-naïve veterans infected with human immunodeficiency virus.
[So] Source:Medicine (Baltimore);97(2):e9495, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Previous studies suggested that human immunodeficiency virus (HIV) infected patients at risk of poor adherence were not distinguishable only based on the baseline characteristics. This study is to identify patient characteristics that would be consistently associated with poor adherence across regimens and to understand the associations between initial and long-term adherence. HIV treatment-naïve patients initiated on protease inhibitors, nonnucleoside reverse transcriptase inhibitors, or integrase strand transfer inhibitors were identified from the Veteran Health Administration system. Initial adherence measured as initial coverage ratio (ICR) and long-term adherence measured as thereafter 1-year proportion days covered (PDC) of base agent and complete regimen were estimated for each patient. The patients most likely to exhibit poor adherence were African-American, with lower socioeconomic status, and healthier. The initial coverage ratio of base agent and complete regimen were highly correlated, but the correlations between ICR and thereafter 1-year PDC were low. However, including initial adherence as a predictor in predictive model would substantially increase predictive accuracy of future adherence.
[Mh] Termos MeSH primário: Infecções por HIV/tratamento farmacológico
Inibidores de Integrase de HIV/uso terapêutico
Adesão à Medicação
Inibidores de Proteases/uso terapêutico
Inibidores da Transcriptase Reversa/uso terapêutico
[Mh] Termos MeSH secundário: Análise de Variância
Feminino
Infecções por HIV/diagnóstico
Infecções por HIV/epidemiologia
Integrase de HIV
Nível de Saúde
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Prognóstico
Estudos Retrospectivos
Fatores de Risco
Fatores Socioeconômicos
Estados Unidos
United States Department of Veterans Affairs
Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HIV Integrase Inhibitors); 0 (Protease Inhibitors); 0 (Reverse Transcriptase Inhibitors); EC 2.7.7.- (HIV Integrase)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009495


  3 / 6161 MEDLINE  
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[PMID]:29289257
[Au] Autor:DeWaters AL; Chansard M; Anzueto A; Pugh MJ; Mortensen EM
[Ad] Endereço:VA North Texas Health Care System, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas.
[Ti] Título:The Association Between Major Depressive Disorder and Outcomes in Older Veterans Hospitalized With Pneumonia.
[So] Source:Am J Med Sci;355(1):21-26, 2018 01.
[Is] ISSN:1538-2990
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Major depressive disorder ("depression") has been identified as an independent risk factor for mortality for many comorbid conditions, including heart failure, cancer and stroke. Major depressive disorder has also been linked to immune suppression by generating a chronic inflammatory state. However, the association between major depression and pneumonia has not been examined. The aim of this study was to examine the association between depression and outcomes, including mortality and intensive care unit admission, in Veterans hospitalized with pneumonia. MATERIALS AND METHODS: We conducted a retrospective national study using administrative data of patients hospitalized at any Veterans Administration acute care hospital. We included patients ≥65 years old hospitalized with pneumonia from 2002-2012. Depressed patients were further analyzed based on whether they were receiving medications to treat depression. We used generalized linear mixed effect models to examine the association of depression with the outcomes of interest after controlling for potential confounders. RESULTS: Patients with depression had a significantly higher 90-day mortality (odds ratio 1.12, 95% confidence interval 1.07-1.17) compared to patients without depression. Patients with untreated depression had a significantly higher 30-day (1.11, 1.04-1.20) and 90-day (1.20, 1.13-1.28) mortality, as well as significantly higher intensive care unit admission rates (1.12, 1.03-1.21), compared to patients with treated depression. CONCLUSION: For older veterans hospitalized with pneumonia, a concurrent diagnosis of major depressive disorder, and especially untreated depression, was associated with higher mortality. This highlights that untreated major depressive disorder is an independent risk factor for mortality for patients with pneumonia.
[Mh] Termos MeSH primário: Transtorno Depressivo Maior/diagnóstico
Transtorno Depressivo Maior/mortalidade
Hospitalização/tendências
Pneumonia/diagnóstico
Pneumonia/mortalidade
Veteranos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Bases de Dados Factuais/tendências
Transtorno Depressivo Maior/psicologia
Feminino
Seres Humanos
Masculino
Mortalidade/tendências
Pneumonia/psicologia
Estudos Retrospectivos
Fatores de Risco
Estados Unidos/epidemiologia
United States Department of Veterans Affairs/tendências
Veteranos/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180101
[St] Status:MEDLINE


  4 / 6161 MEDLINE  
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[PMID]:29344616
[Au] Autor:Daley J
[Ad] Endereço:Cigna Corp, Newton, Massachusetts.
[Ti] Título:Ensuring Timely Access to Quality Care for US Veterans.
[So] Source:JAMA;319(5):439-440, 2018 Feb 06.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde
Qualidade da Assistência à Saúde
Veteranos
[Mh] Termos MeSH secundário: Serviços de Saúde Comunitária/organização & administração
Seres Humanos
Assistência Centrada no Paciente
Fatores de Tempo
Estados Unidos
United States Department of Veterans Affairs
Saúde dos Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180119
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20743


  5 / 6161 MEDLINE  
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[PMID]:29369854
[Au] Autor:Harrigan PN
[Ad] Endereço:Pamela N. Harrigan, BSN, RN El Paso, TX.
[Ti] Título:Veterans and Mental Health.
[So] Source:Am J Nurs;118(2):10, 2018 02.
[Is] ISSN:1538-7488
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Saúde Mental
Veteranos/psicologia
[Mh] Termos MeSH secundário: Seres Humanos
Transtornos Mentais
Serviços de Saúde Mental
Transtornos de Estresse Pós-Traumáticos
Estados Unidos
United States Department of Veterans Affairs
Saúde dos Veteranos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/01.NAJ.0000530226.63705.c3


  6 / 6161 MEDLINE  
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[PMID]:29239024
[Au] Autor:Quin JA; Hattler B; Shroyer ALW; Kemp D; Almassi GH; Bakaeen FG; Carr BM; Bishawi M; Collins JF; Grover FL; Wagner TH; Department of Veteran Affairs (CSP#517-FS) ROOBY Follow-up Study's Endpoints Committee
[Ad] Endereço:Surgical Service, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts.
[Ti] Título:Concordance between administrative data and clinical review for mortality in the randomized on/off bypass follow-up study (ROOBY-FS).
[So] Source:J Card Surg;32(12):751-756, 2017 Dec.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The optimal methodology to identify cardiac versus non-cardiac cause of death following cardiac surgery has not been determined. METHODS: The Randomized On/Off Bypass Trial was a multicenter, randomized, controlled clinical trial of 2203 patients (February 2002-May 2008) comparing 1-year cardiac outcomes between off-pump and on-pump bypass surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program funded a follow-up study to assess 5-year outcomes including mortality. Deaths were identified and confirmed using the National Death Index (NDI), VA Vital Status file, and medical records. An Endpoints Committee (EC) reviewed patient medical records and classified each cause of death as cardiac, non-cardiac, or unknown. Using pre-determined ICD-10 codes, NDI death certificates were independently used to classify deaths as cardiac or non-cardiac. Cause of death was compared between the NDI and EC classifications and concordance measured, using Kappa statistics. RESULTS: Of the 297 5-year deaths identified by the NDI and/or VA vital status file and confirmed by the EC, 219 had adequate patient records for EC cause of death determination. The EC adjudicated 141 of these deaths as non-cardiac and 78 as cardiac, while the NDI classified 150 as non-cardiac and 69 as cardiac; agreement was 77.6% (kappa 0.500; P < 0.001). CONCLUSIONS: Since concordance between EC and NDI cause of death classifications was only moderate, caution should be exercised in relying exclusively on NDI data to determine cause of death. A hybrid approach, integrating multiple information sources, may provide the most accurate approach to classifying cause of death.
[Mh] Termos MeSH primário: Causas de Morte
Ponte de Artéria Coronária sem Circulação Extracorpórea
Doença da Artéria Coronariana/mortalidade
Doença da Artéria Coronariana/cirurgia
Registros Médicos
Sistema de Registros
[Mh] Termos MeSH secundário: Feminino
Seguimentos
Seres Humanos
Masculino
Estudos Prospectivos
Estados Unidos
United States Department of Veterans Affairs
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13379


  7 / 6161 MEDLINE  
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[PMID]:29240348
[Au] Autor:Wehner SD; Saiz YV; Woodard H; Garcia D
[Ti] Título:Avoiding Same-Day Cystoscopy Cancellations by Veterans: Nurse-Led Education Improved Efficiency for Cystoscopy in VA Urology Clinics.
[So] Source:Urol Nurs;36(6):275-81, 2016 Nov-Dec.
[Is] ISSN:1053-816X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Same-day cancellation of outpatient cystoscopy was recognized as a growing problem in a New Mexico Veterans Administration regional urology clinic. A multidisciplinary team initiated a performance improvement project using the VA-TAMMCS method to address the problem. The resulting changes in patient education significantly reduced cystoscopy cancellations and improved overall patient satisfaction.
[Mh] Termos MeSH primário: Agendamento de Consultas
Cistoscopia
Enfermagem em Nefrologia
Educação de Pacientes como Assunto/métodos
Satisfação do Paciente
Veteranos
[Mh] Termos MeSH secundário: Seres Humanos
Padrões de Prática em Enfermagem
Estados Unidos
United States Department of Veterans Affairs
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE


  8 / 6161 MEDLINE  
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[PMID]:28505056
[Au] Autor:Gilmartin HM; Langner P; Gokhale M; Osatuke K; Hasselbeck R; Maddox TM; Battaglia C
[Ad] Endereço:Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Health Care System, Denver, Colorado (Drs Gilmartin, Maddox, and Battaglia and Mss Langner and Gokhale); and National Center for Organization Development (Dr Osatuke) and Inpatient Evaluation Center, Office of Informatics and Analytics (Ms Hasselbeck), Veterans Health Administration Cincinnati, Ohio.
[Ti] Título:Relationship Between Psychological Safety and Reporting Nonadherence to a Safety Checklist.
[So] Source:J Nurs Care Qual;33(1):53-60, 2018 Jan/Mar.
[Is] ISSN:1550-5065
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. Thus, an analysis of organizational data was conducted to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. Considerations for this finding and assessing psychological safety are provided.
[Mh] Termos MeSH primário: Lista de Checagem/utilização
Erros Médicos/estatística & dados numéricos
Papel do Profissional de Enfermagem
Segurança do Paciente/normas
[Mh] Termos MeSH secundário: Enfermagem de Cuidados Críticos
Coleta de Dados
Seres Humanos
Erros Médicos/psicologia
Cultura Organizacional
Estados Unidos
United States Department of Veterans Affairs
Local de Trabalho/organização & administração
Local de Trabalho/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170516
[St] Status:MEDLINE
[do] DOI:10.1097/NCQ.0000000000000265


  9 / 6161 MEDLINE  
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[PMID]:29216276
[Au] Autor:Reveles KR; Lawson KA; Mortensen EM; Pugh MJV; Koeller JM; Argamany JR; Frei CR
[Ad] Endereço:College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America.
[Ti] Título:National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014.
[So] Source:PLoS One;12(12):e0189227, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Prior studies demonstrated marked increases in Clostridium difficile infection (CDI) in the United States (U.S.) in recent years. The objective of this study was to describe the epidemiology of initial and recurrent CDI in a national Veterans Health Administration (VHA) cohort over a 12-year period. METHODS: This was a retrospective cohort study of all adult VHA beneficiaries with CDI (ICD-9-CM code 008.45) plus a positive CDI stool test between October 1, 2002 and September 30, 2014. Data were obtained from the VA Informatics and Computing Infrastructure. Recurrence was defined as a second ICD-9-CM code plus a new course of CDI therapy following a minimum three-day gap after the initial therapy was completed. CDI incidence and outcomes were presented descriptively and longitudinally. RESULTS: Overall, 30,326 patients met study inclusion criteria. CDI incidence increased from FY 2003 (1.6 per 10,000) to FY 2013 (5.1 per 10,000). Thereafter, CDI incidence decreased through FY 2014 (4.6 per 10,000). A total of 5,011 patients (17%) experienced a first recurrence and, of those, 1,713 (34%) experienced a second recurrence. Recurrence incidence increased 10-fold over the study period, from (0.1 per 10,000) in FY 2003, to (1.0 per 10,000) in FY 2014. Overall, 30-day mortality and median hospital length of stay (LOS) decreased among initial episodes over the study period. Mortality was higher for initial episodes (21%) compared to first recurrences (11%) and second recurrences (7%). Median hospital LOS was longer for first episodes (13 days) compared to first (9 days) and second recurrences (8 days). CONCLUSIONS: Initial and recurrent CDI episodes increased among veterans over a 12-year period. Outcomes, such as mortality and hospital LOS improved in recent years; both of these outcomes are worse for initial CDI episodes than recurrent episodes.
[Mh] Termos MeSH primário: Infecções por Clostridium/epidemiologia
Saúde dos Veteranos
[Mh] Termos MeSH secundário: Idoso
Infecções por Clostridium/terapia
Feminino
Hospitalização
Seres Humanos
Incidência
Tempo de Internação
Masculino
Meia-Idade
Estudos Retrospectivos
Estados Unidos/epidemiologia
United States Department of Veterans Affairs
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189227


  10 / 6161 MEDLINE  
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[PMID]:29231668
[Au] Autor:Department of Veterans Affairs.
[Ti] Título:Ecclesiastical Endorsing Organizations. Final rule.
[So] Source:Fed Regist;82(215):51770-3, 2017 Nov 08.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Department of Veterans Affairs (VA) is amending its medical regulations by establishing in regulation the eligibility requirements that ecclesiastical endorsing organizations must meet in order to provide ecclesiastical endorsements of individuals seeking employment as VA chaplains, or of individuals who are seeking to be engaged by VA under contract or appointed as on-facility fee basis VA chaplains under the United States Code. VA considers veterans' spiritual care an integral part of their overall health care. As such, VA is committed to providing qualified VA chaplains to address the veterans' spiritual needs by engaging chaplains that are ecclesiastically endorsed. Ecclesiastical endorsement certifies that the individual is qualified to perform all the religious sacraments, rites, rituals, ceremonies and ordinances needed by members of a particular faith.
[Mh] Termos MeSH primário: Clero/legislação & jurisprudência
Emprego/legislação & jurisprudência
United States Department of Veterans Affairs/legislação & jurisprudência
Saúde dos Veteranos/legislação & jurisprudência
Veteranos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Definição da Elegibilidade/legislação & jurisprudência
Seres Humanos
Espiritualidade
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE



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