Battle Creek VA Medical Center

Providing youth the opportunity to express their attitudes toward and recommendations for improvement of a home-based physical activity (PA) program may help to improve engagement in virtual PA program activities. Youth voice is an often-overlooked component that may be necessary for understanding what contributes to low participation and may have important implications for long-term adherence. Informed by Self-Determination Theory, this study aimed to formatively evaluate home-based exercise videos, incorporating youth feedback for improvement in the development of the videos. Youth participated in four (8-minute) PA videos varying in type (strength; cardio; mindfulness; sports skill). Youth accessed the videos and answered open-ended questions via an online survey. Data were analyzed using qualitative content analysis to identify emerging themes in responses. Sixty-eight K-12 youth in the United States (52% girls; 38% non-White; 55% in K-5 grade; 17% in 6-8 grade; 28% in 9-12 grade) participated in this study. Overall, 61.9% of affective responses were positive, with mindfulness rating the highest and strength the lowest. Children were satisfied with the video structure, enjoyed having an opportunity to move at home and reported liking the engaging instructors. Suggestions were also given related to modifying video length, adding modifications for varying fitness levels, adding more kid-like features, and providing incentives. Youth recommendations may be used to create tailored adaptations and implementation supports for PA programs in the home. Findings from this study demonstrate that incorporating youth voice may be an important step toward increasing engagement in home-based PA programming.

This study provides ultrasonographic fetal growth charts for the Eastern black-and-white colobus monkey (Colobus guereza). Throughout three consecutive gestations (-162 to -2 days to parturition) in a single dam, we opportunistically obtained ultrasonographic measurements for the following parameters: biparietal diameter, head circumference, humerus length, femur length, tibia length, radius length, thoracic width, kidney length, and crown-rump length. Biparietal diameter was the most consistently measured parameter. First detection of fetuses occurred between 96 and 162 days before parturition. This report demonstrates that voluntary transabdominal ultrasound can be well-tolerated in the colobus monkey using operant conditioning. These findings may be useful to assess fetal development and predict parturition dates in the absence of a known conception date in this species.

Introduction: Transcatheter aortic valve replacement (TAVR) has proven to be safe and efficacious in patients with tricuspid aortic valve (TAV) stenosis. However, due to its anatomic complexity, bicuspid aortic valve (BAV) stenosis has been excluded from previous trials, and data remain limited regarding TAVR in this group of patients. Methods: We searched the databases systematically for relevant studies from inception to March 2022. The primary focus was all-cause mortality at 1-year. Additional outcomes included 30-day mortality, 30-day stroke, and 30-day major vascular complications. Results: We included 28 studies with a total of 346,033 patients who underwent TAVR, of which 17,835 patients had BAV stenosis. The risks of 1-year mortality and 30-day major vascular complications were similar between the 2 groups. However, patients with BAV who underwent TAVR had a higher risk of 30-days mortality (BAV 2.3% vs TAV 2.2%, p=0.02) and 30-day stroke (BAV 2.2% vs TAV 1.8%, p=0.01). A subgroup analysis of 23,623 matched patients of whom 49.5% had BAV stenosis was performed. The risk of 1-year mortality was lower in patients with BAV compared to TAV (BAV 5.8% vs TAV 6.8%, p=0.009). Risks of 30-day mortality, and 30-day major vascular complication were similar between the two groups. However, the risk of 30-day stroke was higher in the BAV group (BAV 2.2% vs TAV 1.7%, p=0.02). Conclusions: In our meta-analysis, among patients who underwent TAVR for aortic stenosis, there was no significant difference between BAV vs TAV in outcomes, except for higher risk of 30-days mortality and stroke. Among matched groups, patients with BAV stenosis undergoing TAVR had comparable outcomes to patients with TAV stenosis except for higher risk of stroke and lower risk of 1-year mortality in BAV group.More studies, specifically randomized trials, are still warranted to further assess efficacy, safety and reassure the long-term outcomes in this group of patients.

The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29,p < .001, η2 = .03). Sensitivity analyses did not detect a similar effect during a prior coping skills phase of treatment. During CPT, clinically significant change was met by 66.7% of non-compensation seeking veterans (M = -15, SD = 14.56) and by 40.1% of the compensation seeking group (M = -7.1, SD = 12.24). Compensation-seeking may be associated with reduced response to trauma-focused treatment in certain settings. Future research is needed to better understand the mechanisms underlying this effect.

The actions needed to mitigate the spread of the coronavirus 2019 (COVID-19) have forged rapid paradigm shifts across healthcare delivery. In a time of crisis, continued access to and delivery of medication for opioid use disorder (M-OUD) is essential to save lives. However, prior to COVID-19, large variability in M-OUD adoption existed across the Veteran Health Administration (VHA) and it is unknown whether the COVID-19 pandemic exacerbated this divide. For the past two years, our team worked with eight VHA facilities to enhance adoption of M-OUD through a multi-component implementation intervention. This commentary explores these providers’ responses to COVID-19 and the subsequent impact on their progress toward increasing adoption of M-OUD. Briefly, the loosening of regulatory restrictions fostered accelerated adoption of M-OUD, rapid support for telehealth offered a mechanism to increase M-OUD access, and reevaluation of current practices surrounding M-OUD strengthened adoption. Overall, during the COVID-19 crisis, facilities and providers responded positively to the call for increased access to M-OUD and appropriate care of patients with OUD. The VHA providers’ responses and continued progress in enhancing M-OUD amidst a crisis may, in part, be attributable to their participation in an implementation effort prior to COVID-19 that established resources, expert support, and a community of practice. We anticipate the themes presented are generalizable to other healthcare systems grappling to deliver care to patients with OUD during a crisis. We propose areas of future research and quality improvement to continue to provide access and high quality, life-saving care to patients with OUD.

Discuss issues of musculoskeletal rehabilitation unique to the aging female population. Physiologic and anatomic changes contribute to functional decline, morbidity, and mortality in aging women. As the lifespan increases, the burden of pain-related disability impacts women more commonly than men. Maintaining physical activity plays an important role in reducing the burden of disability. Physical function limitations are potentially modifiable but prevention is preferable. Further research in prevention and management of rehabilitation issues (including sarcopenia, frailty, and bone and joint disease) in aging women is important.

ABSTRACT Patient education is an integral component for compliance with dermatologic medical treatments. This column has been developed in partnership with the caring nurses dedicated to optimizing patient care through practicum-based education and treatment. This article focuses on postbiopsy care.

Introduction:Quetiapine fumarate is an atypical antipsychotic approved for the treatment of schizophrenia, major depressive disorder, and bipolar disorder. Due to the sedative effects observed at low doses, prescribers use quetiapine to aid patients with sleep disturbances. Current evidence has established that quetiapine can cause negative changes in metabolic parameters, but it is unknown if these consequences also occur at low doses. Due to the use of quetiapine for sleep, the purpose of this study is to identify if metabolic effects are also a risk with the use of low-dose quetiapine.Methods:Eligible subjects were identified through the Veterans Affairs electronic medical records as having an active prescription for quetiapine from June 30, 2012, through September 1, 2013. Subjects were then evaluated using inclusion and exclusion criteria for determination of study entrance. Descriptive statistics and t tests were utilized to identify clinical and statistical differences in outcomes.Results:A total of 403 subjects were included in the final analysis. The average dose of quetiapine was 116.8 mg and average duration of therapy was 44 months. Increases were observed in systolic blood pressure (+1.95 mmHg; P = .036), diastolic blood pressure (+1.97 mmHg; P = .001), body mass index (+0.52; P = .001), weight (+1.88 kg; P = .002), and fasting blood glucose (+6.71 mg/dL; P = .002). Conversely, a decrease in total cholesterol (−10.06 mg/dL; P < .001) was recognized.Discussion:As a result of the findings, there may be negative metabolic consequences with the use of low-dose quetiapine. Routine prescribing of low doses for sleep as a first-line medication should be avoided.

The global marketplace is characterized by various changes occurring in economic, social, natural, and technological areas. As such, experts in numerous fields are still working to revise various systems and infrastructures to operate in a robust manner within the new realities of today. This article focuses on part of that massive effort by examining the methods used in teaching English as a Foreign Language (EFL) in non-English speaking countries and its potential impact on long-term economic sustainability and productivity since English remains the global business language. The article commences with an introduction to the realities of contemporary globalism that underscore the very purpose for this work, and the subsequent sections present and then synthesize all material to create a paradigm shift in thinking required for teaching EFL in non-English speaking nations.