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[PMID]:29461352
[Au] Autor:Omogbai T; Milner KA
[Ad] Endereço:Author Affiliations: Nurse Manager (Mr Omogbai), Hudson Valley Veteran Affairs Healthcare System, New York; Associate Professor (Dr Milner), College of Nursing, Sacred Heart University, Fairfield, Connecticut.
[Ti] Título:Implementation and Evaluation of Shared Medical Appointments in Veterans With Diabetes: A Quality Improvement Study.
[So] Source:J Nurs Adm;48(3):154-159, 2018 Mar.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study is to implement and evaluate shared medical appointments (SMA) in veterans with diabetes. BACKGROUND: Health systems are challenged to meet the complex care needs of veterans with diabetes. Use of SMA has resulted in significant improvements in A1c, blood pressure, and self-management skills in this population. METHODS: Shared medical appointments were implemented in a Veterans Administration Health System. A1c, blood pressure, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, weight, and height were collected at baseline, 3 months, and 6 months; hospitalization anytime; and veteran satisfaction at baseline and 6 months. RESULTS: From October 15, 2015, to March 15, 2016, 30 male veterans with diabetes participated in monthly SMA. Outcome measures except for high-density lipoprotein improved significantly (P < .02) from baseline to 6 months. No veterans were hospitalized. Veteran satisfaction increased significantly (P < .001). CONCLUSION: Shared medical appointment can be a highly effective intervention for veterans with diabetes. Nursing leaders need to be at the forefront of implementing SMA for populations with chronic conditions.
[Mh] Termos MeSH primário: Agendamento de Consultas
Doenças Cardiovasculares/prevenção & controle
Diabetes Mellitus/terapia
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Melhoria de Qualidade/organização & administração
Saúde dos Veteranos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doenças Cardiovasculares/diagnóstico
Doenças Cardiovasculares/epidemiologia
Comorbidade
Complicações do Diabetes/prevenção & controle
Complicações do Diabetes/terapia
Processos Grupais
Pesquisas sobre Serviços de Saúde
Implementação de Plano de Saúde
Seres Humanos
Masculino
Registros Médicos
New York
Estudos de Casos Organizacionais
Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos
Avaliação de Programas e Projetos de Saúde
Melhoria de Qualidade/normas
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000590


  2 / 799 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


  3 / 799 MEDLINE  
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[PMID]:29391106
[Au] Autor:Sun BJ; Valdez D; Duong D; Gupta R; Smith BR
[Ad] Endereço:Department of Surgery, Veteran Affairs Long Beach Healthcare System, Long Beach, California, USA.
[Ti] Título:Evaluation of Preoperative Weight Loss for Elective Hernia Repair in the Veteran Population.
[So] Source:Am Surg;83(10):1112-1116, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The safety and efficacy of preoperative weight loss before elective nonbariatric surgery is controversial. We evaluated the effect of planned surgical delay for a preoperative weight loss trial in hernia repairs. Four hundred and fourteen patients undergoing elective hernia repair between July 2008 and May 2012 at a Level 1B VA Medical Center were identified. Included patients were divided into two groups: those who underwent immediate hernia repair (nontrial) and those who underwent weight loss trial before hernia repair (TRIAL). Twenty-two patients were categorized in the TRIAL group, and 392 in nontrial. Time from surgical evaluation to operation was longer in the TRIAL vs nontrial group (226 days vs 113 days, P = 0.001). Outcome measures were similar between groups. Net change in body mass index (BMI) was -2.2 per cent in TRIAL vs -0.86 per cent in nontrial patients (P = 0.440). Of the TRIAL patients, ten obtained a poor result (<3% decreased BMI), nine a moderate result (3-10% decreased BMI), and three a good result (>10% decreased BMI). Weight loss trials in elective hernia patients appear to be safe, although they result in significant delay to surgery and confer no difference in postoperative outcomes. Thus, efficacy of preoperative weight loss trials may be limited.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Eletivos
Hérnia Inguinal/cirurgia
Hérnia Ventral/cirurgia
Herniorrafia
Cuidados Pré-Operatórios/métodos
Saúde dos Veteranos
Programas de Redução de Peso
[Mh] Termos MeSH secundário: Idoso
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
Perda de Peso
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  4 / 799 MEDLINE  
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[PMID]:29328560
[Au] Autor:Samardzic RM; Zivic B; Krstic D; Jokovic D; Dolic M; Stojanovic Z; Eror A; Dokic M; Milojevic S; Mandic-Gajic G
[Ti] Título:Re-evaluating disability assessment in war veterans with posttraumatic stress disorder.
[So] Source:Vojnosanit Pregl;73(10):945-9, 2016 Oct.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. Methods: The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans' military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale ­ CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. Results: There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. Conclusion: The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.
[Mh] Termos MeSH primário: Avaliação da Deficiência
Transtornos de Estresse Pós-Traumáticos/diagnóstico
Saúde dos Veteranos
Veteranos/psicologia
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Seguro por Invalidez
Masculino
Meia-Idade
Variações Dependentes do Observador
Equipe de Assistência ao Paciente
Valor Preditivo dos Testes
Prognóstico
Psiquiatria
Reprodutibilidade dos Testes
Índice de Gravidade de Doença
Transtornos de Estresse Pós-Traumáticos/economia
Transtornos de Estresse Pós-Traumáticos/psicologia
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150124090S


  5 / 799 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 / 799 MEDLINE  
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[PMID]:29320139
[Au] Autor:Department of Veterans Affairs.
[Ti] Título:Reimbursement for Emergency Treatment. Interim final rule.
[So] Source:Fed Regist;83(6):974-80, 2018 Jan 09.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Department of Veterans Affairs (VA) revises its regulations concerning payment or reimbursement for emergency treatment for non-service-connected conditions at non-VA facilities to implement the requirements of a recent court decision. Specifically, this rulemaking expands eligibility for payment or reimbursement to include veterans who receive partial payment from a health-plan contract for non-VA emergency treatment and establishes a corresponding reimbursement methodology. This rulemaking also expands the eligibility criteria for veterans to receive payment or reimbursement for emergency transportation associated with the emergency treatment, in order to ensure that veterans are adequately covered when emergency transportation is a necessary part of their non-VA emergency treatment.
[Mh] Termos MeSH primário: Serviços Médicos de Emergência/economia
Reembolso de Seguro de Saúde/legislação & jurisprudência
Saúde dos Veteranos/economia
Saúde dos Veteranos/legislação & jurisprudência
Veteranos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Definição da Elegibilidade/legislação & jurisprudência
Seres Humanos
Transporte de Pacientes/economia
Transporte de Pacientes/legislação & jurisprudência
Estados Unidos
[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:T
[Da] Data de entrada para processamento:180111
[St] Status: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


  8 / 799 MEDLINE  
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[PMID]:29232075
[Au] Autor:Department of Veterans Affairs.
[Ti] Título:Extra-Schedular Evaluations for Individual Disabilities. Final rule.
[So] Source:Fed Regist;82(235):57830-5, 2017 Dec 08.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Department of Veterans Affairs (VA) amends its adjudication regulation pertaining to extra-schedular consideration of a service-connected disability in exceptional compensation cases. This rule clarifies that an extra-schedular evaluation is to be applied to an individual service-connected disability when the disability is so exceptional or unusual that it makes application of the regular rating schedule impractical. An extra-schedular evaluation may not be based on the combined effect of more than one service-connected disability. For the reasons set forth in the proposed rule and in this final rule, VA is adopting the proposed rule as final, with two changes, as explained below.
[Mh] Termos MeSH primário: Avaliação da Deficiência
Saúde dos Veteranos/legislação & jurisprudência
Veteranos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Pessoas com Deficiência/legislação & jurisprudência
Seres Humanos
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


  9 / 799 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


  10 / 799 MEDLINE  
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[PMID]:28973196
[Au] Autor:Belperio PS; Chartier M; Ross DB; Alaigh P; Shulkin D
[Ad] Endereço:From VA Palo Alto Health Care System, Palo Alto, California; San Francisco VA Medical Center, San Francisco, California; and U.S. Department of Veterans Affairs, Washington, DC.
[Ti] Título:Curing Hepatitis C Virus Infection: Best Practices From the U.S. Department of Veterans Affairs.
[So] Source:Ann Intern Med;167(7):499-504, 2017 Oct 03.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The U.S. Department of Veterans Affairs (VA) is the nation's largest care provider for hepatitis C virus (HCV)-infected patients and is uniquely suited to inform national efforts to eliminate HCV. An extensive array of delivery of services, policy guidance, outreach efforts, and funding has broadened the reach and capacity of the VA to deliver direct-acting antiviral (DAA) HCV therapy, supported by an infrastructure to effectively implement change and informed by extensive population health data analysis. The VA has treated more than 92 000 HCV-infected veterans since all-oral DAAs became available in January 2014, with cure rates exceeding 90%; only 51 000 veterans in VA care are known to remain potentially eligible for treatment. Key actions advancing the VA's aggressive treatment of HCV infection that are germane to non-VA settings include expansion of treatment capacity through the use of nonphysician providers, video telehealth, and electronic technologies; expansion of integrated care to address psychiatric and substance use comorbidities; and electronic data tools for patient tracking and outreach. A critical component of effective implementation has been building infrastructure through the creation of regional multidisciplinary HCV Innovation Teams, whose system redesign efforts have produced innovative HCV practice models addressing gaps in care while providing more efficient and effective HCV management for the populations they serve. Financing for HCV treatment and infrastructure resources coupled with reduced drug prices has been paramount to the VA's success in curing HCV infection. The VA is poised to share and extend best practices to other health care organizations and providers delivering HCV care, contributing to a concerted effort to reduce the overall burden of HCV infection.
[Mh] Termos MeSH primário: Antivirais/uso terapêutico
Hepatite C/tratamento farmacológico
United States Department of Veterans Affairs
[Mh] Termos MeSH secundário: Comorbidade
Assistência à Saúde/métodos
Feminino
Financiamento Governamental
Hepatite C/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Telemedicina
Estados Unidos/epidemiologia
United States Department of Veterans Affairs/economia
Veteranos/estatística & dados numéricos
Saúde dos Veteranos/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiviral Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.7326/M17-1073



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