Bay Pines VA Healthcare System

This clinical study aimed to discuss the delivery and outcome of virtual group care for Veterans receiving progressive tinnitus management (PTM) services in the Bay Pines Veterans Affairs (VA) Healthcare System. Virtual group PTM was provided to Veterans during fiscal years (FYs) 2022-2024 using the VA Video Connect (VVC) platform. Outcome measures were obtained via the Tinnitus Workshop Follow-Up form after completion of the virtual workshops. Outcome data collected for FYs 2022-2024 showed that 80% of the respondents used all four strategies instructed in the workshops (using sound, relaxation, planning activities, changing unhelpful thoughts about tinnitus). Specifically, 94% reported using sound, 94% used relaxation strategies, 92% reported planning activities, and 88% reported changing unhelpful thoughts about tinnitus. The majority of respondents reported an improved sense of control of tinnitus (68%), improved ability to cope with tinnitus (68%), improved overall quality of life (QOL; 67%), and less bothersome tinnitus (60%) after participating in the workshops. Ninety-three percent of respondents recommended the workshops for other Veterans with bothersome tinnitus. Sixty percent requested text messages to support their tinnitus plan of care. Clinical outcomes of care delivered to Veterans with bothersome tinnitus showed use of the PTM coping strategies and improved QOL indicators after completion of care, with 93% of the respondents recommending virtual group PTM care to other Veterans with bothersome tinnitus. Veterans were receptive to receiving text messages to supplement their tinnitus plan of care. Clinical tele-audiology services for group participants in the VA can be successfully delivered via the VVC platform for a variety of audiologic needs including bothersome tinnitus.

BackgroundTraumatic rib fractures can lead to respiratory complications necessitating unplanned intubation, but predictors have been inadequately delineated. We used interpretable machine learning to predict unplanned intubations in rib fracture patients while identifying predictors.MethodsTQIP 2017-2022 was queried for adult patients admitted to the hospital following a rib fracture injury. An XGBoost model was developed to predict unplanned intubation using variables that can be known on admission. A 70/10/20 train/validation/test split was used. SHapley Additive exPlanations (SHAP) were used for interpretation. SHAP allows individualized interpretation of predictors for each patient.ResultsThe cohort had 905615 patients; 2.3% had unplanned intubations. Model metrics at the F1 maximizing threshold (0.78) included AUROC = 0.83, F1 score = 0.17, accuracy = 0.94, precision = 0.12, recall = 0.29, specificity = 0.95, and Brier score = 0.17. The most influential variables, as determined by mean absolute SHAP values, were admission location (0.62), Injury Severity Score (0.40), age (0.37), absence of comorbidities (0.18), pulse rate (0.14), pneumothorax (0.13), oxygen saturation (0.15), chronic obstructive pulmonary disease (0.11), respiratory rate (0.10), and sex (0.10). ICU admission was the location most influential in predicting an unplanned intubation. SHAP dependency plots determined the directional relationship between variables' values and SHAP values.DiscussionPatients above the F1 maximizing threshold had a 7.4-fold increase in unplanned intubations compared to those below. Nearly 30% of all unplanned intubations were captured at this threshold. Our model's identification of these high-risk patients and influential factors not previously considered in the literature could guide closer monitoring and early interventions.

Women veterans (WV) present to Veterans Health Administration with mental health and medical treatment needs that differ from men and civilian women. Primary Care-Mental Health Integration (PC-MHI), which provides short-term, evidence-based mental health care, is often the first point of mental health assessment and intervention for veterans. Little research exists on gender-specific care, procedures, and impact for WV in PC-MHI, and many mental health providers feel ill-trained to address WV-specific concerns. This project aimed to identify the unique mental health necessities of WV within PC-MHI as compared with men, to support Veterans Health Administration Directive 1330.01 regarding providing gender-specific care, cultural competence among mental health providers, and underresearched areas for further exploration to make a valuable contribution to the mission of PC-MHI regarding training, education, and implementation of gender-specific procedures. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, nine sources published between 2005 and 2023 were included. Results were organized by gender comparisons, gender-specific care in PC-MHI, and mental health for WV. Preliminary sources indicate that WV present to PC-MHI with nuanced mental health concerns and utilize PC-MHI more than men. Subsequently, PC-MHI has promising potential to address gender-specific needs for WV. This review highlights the need for adaptation in mental health screening for WV in periods of increased mental health risk (e.g., postpartum) and across the lifespan. Findings emphasize the need for additional research on WV needs and gender-specific care in PC-MHI, as well as increased provider training, and establishment of evidence-based clinical guidelines and policies for WV in PC-MHI. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study examined associations of compliance rate with the reliability and convergent validity of intoxication and negative affect assessments in experience sampling method (ESM) data in three samples (Veterans, Sexual Minority Men, and College Students). Convergent validity was operationalized as within-person associations between daily aggregates of random in situ assessments and retrospective daily assessments or transdermal alcohol assessments. Measures with lower ICC require more assessments for a reliable aggregate (e.g., daily mean). In this regard, the number of completed assessments and intraclass correlation (ICC), rather than compliance with the protocol per se, determines reliability. Although convergent validity was correlated with compliance rate, the relatively weak associations reflect that there are individuals with excellent compliance yet poor convergent validity as well as individuals with poor compliance and excellent convergent validity. The pattern of results does not show a clear threshold for compliance (e.g., 80%) that differentiates good versus poor validity.

There is continuing uncertainty about the safety of early chemoprophylaxis for venous thromboembolism (VTE) in patients with traumatic brain injury (TBI). The objective of this paper was to 1) calculate the risk of progression of posttraumatic intracranial hemorrhage (ICH) after VTE chemoprophylaxis, and 2) compare the probability of ICH progression in early versus late VTE prophylaxis. The authors searched for English-language literature from database inception to January 2023. Two independent reviewers selected studies on post-TBI VTE chemoprophylaxis in hospitalized patients. Study parameters included ICH progression (as determined by follow-up imaging after starting chemoprophylaxis) in relation to use versus nonuse, timing, and type of VTE chemoprophylaxis. Pertinent variables included author, year, study type, demographic variables, cranial and systemic Injury Severity Scores, and data documenting ICH progression or indirect evidence of TBI worsening after the initiation of VTE chemoprophylaxis. Thirty studies fulfilled the inclusion criteria. There was a 7.0% (95% CI 4.0%-10.0%) risk of CT-documented ICH progression following VTE chemoprophylaxis in the prophylactically treated group. There was no difference between the early versus late VTE prophylaxis groups for ICH progression (12 studies; OR 0.79 [95% CI 0.56-1.12]). There was also no significant difference in CT-documented ICH progression between the prophylactically treated and nontreated groups (5 studies; OR 0.57 [95% CI 0.28-1.18]). The review of the literature shows that VTE chemoprophylaxis 72 hours after TBI is considered safe by the majority of authors. This meta-analysis did not reveal any evidence of increased risk of ICH when starting VTE chemoprophylaxis earlier, i.e., within 72 hours of TBI; however, it is important to emphasize that only a small number of lower-quality studies addressed the 48-hour or 24-hour time point. A randomized noninferiority trial should be the next step in answering the question of early (within 72 hours) VTE chemoprophylaxis after TBI.

Abstract Objective Greater functional impairment has been associated with higher rates of progression to dementia. Identifying sensitive functional measures that can detect early ADRD have immediate implications for prognosis, especially among ethnically diverse groups who are disproportionately affected. The modified Clinical Dementia Rating scale (mCDR) is a multiple-choice format assessment that assesses the five domains of the Clinical Dementia Rating scale. The current study aimed to compare sensitivity and specificity of the mCDR between White non-Hispanic (WNH) and Hispanic participants. Methods The mCDR was administered in the patient’s primary language (English or Spanish) to 101 WNH Cognitively Normal (CN, n=20) and with MCI (n=81) and 159 Hispanic CN (n=32) and MCI (n=127) participants. Sensitivity to MCI diagnosis and Specificity to CN, using the mCDR “mean of means” total score, was quantified via Area under the Curve (AUC) calculated from a Receiver Operating Characteristic analysis. Results Among WNH participants, the mCDR score demonstrated 78% Sensitivity and 90% Specificity (AUC = .88; CI95%= .81, .94). Among Hispanics, the mCDR showed 61% Sensitivity and 78% specificity (AUC = .73; CI95%= .64, .83). AUC was significantly worse for Hispanic participants. Conclusion The mCDR is a tool that can be used by a trained psychometrist to facilitate focused answers and reduce administration time when assessing clinical functioning among dementia populations. It demonstrated excellent discrimination between CN and MCI among WNHs and acceptable discrimination among Hispanic individuals. Future research should further examine the utility of this tool for Hispanic older adults in early diagnosis of ADRD.

This Viewpoint highlights the increasing levels of burnout among physicians, discusses how burnout can erode professionalism, and suggests possible steps physicians and health care organizations might take to lessen burnout and maintain professionalism in the setting of burnout.

Personalized genomic classifiers have transformed the management of prostate cancer (PCa) by identifying the most aggressive subsets of PCa. Nevertheless, the performance of genomic classifiers to risk classify African American men is thus far lacking in a prospective setting. This is a prospective study of the Decipher genomic classifier for National Comprehensive Cancer Network low- and intermediate-risk PCa. Study-eligible non-African American men were matched to African American men. Diagnostic biopsy specimens were processed to estimate Decipher scores. Samples accrued in NCT02723734, a prospective study, were interrogated to determine the genomic risk of reclassification (GrR) between conventional clinical risk classifiers and the Decipher score. The final analysis included a clinically balanced cohort of 226 patients with complete genomic information (113 African American men and 113 non-African American men). A higher proportion of African American men with National Comprehensive Cancer Network-classified low-risk (18.2%) and favorable intermediate-risk (37.8%) PCa had a higher Decipher score than non-African American men. Self-identified African American men were twice more likely than non-African American men to experience GrR (relative risk [RR] = 2.23, 95% confidence interval [CI] = 1.02 to 4.90; P = .04). In an ancestry-determined race model, we consistently validated a higher risk of reclassification in African American men (RR = 5.26, 95% CI = 1.66 to 16.63; P = .004). Race-stratified analysis of GrR vs non-GrR tumors also revealed molecular differences in these tumor subtypes. Integration of genomic classifiers with clinically based risk classification can help identify the subset of African American men with localized PCa who harbor high genomic risk of early metastatic disease. It is vital to identify and appropriately risk stratify the subset of African American men with aggressive disease who may benefit from more targeted interventions.