James A. Haley Veterans' Hospital

Splenic flexure mobilization (SFM) is occasionally utilized during sigmoidectomy to facilitate a tension-free colorectal anastomosis. Present literature regarding its use, safety, and efficacy predominantly evaluates traditional laparoscopic vs. open techniques, thus not adequately representing the current minimally invasive surgical landscape. This retrospective cohort analysis evaluated SFM during sigmoidectomy for diverticular disease via traditional laparoscopic, single-incision laparoscopic, and robotic techniques at a United States academic institution from 2019 to 2022. Primary outcomes were the rate of SFM, independent predictors, and short-term outcomes. A total of 117 patients underwent sigmoidectomy for diverticulitis by six colorectal surgeons, of whom 27 underwent SFM. SFM was associated with higher rates of complicated diverticulitis (85.2% vs. 46.7%, p < 0.001), including abscess (55.6% vs. 33.3%, p = 0.037) and fistulae (59.3% vs. 17.8%, p < 0.001). Presence of a fistula was an independent predictor of SFM by logistic regression (odds ratio [OR], 5.886; p < 0.001). Mobilization was associated with more concomitant surgical procedures (66.7% vs. 28.9%, p < 0.001). There was a significant association between SFM and conversion to open approach (14.8% vs. 3.3%, p = 0.049), longer length of stay (4.2 ± 2.8 days vs. 3.6 ± 4.3 days, p = 0.041), and increased operative time (241.7 ± 76.4 minutes vs. 199.2 ± 75.7 minutes). There was no difference in 30-day morbidity/mortality. Routine SFM can be considered in minimally invasive sigmoidectomy for complicated diverticulitis without significant impact on 30-day morbidity/mortality regardless of surgical approach and may be anticipated preoperatively, particularly when a fistula is present.

Myeloid neoplasms (MNs) with germline predisposition represent a distinct, increasingly recognized category in the WHO classification, encompassing myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) arising in the context of an inherited genetic alteration or mutation. While often presenting at a younger age or with characteristic cytopenias with or without organ dysfunction, some can manifest in adulthood, highlighting the need for vigilance regardless of age or family history. Key predisposing genes include transcription factors (e.g., RUNX1, CEBPA) and genes involved in RNA splicing and telomere biology disorders. Identification of these germline mutations is critical as MNs with germline predisposition dictate specific therapeutic strategies-particularly for hematopoietic stem cell transplantation (HSCT)-and require genetic counseling and surveillance for at-risk relatives. Accurate diagnosis often requires non-hematopoietic germline DNA testing, which provides important biological insights into the development of different myeloid neoplasms and directs personalized patient care.

Abstract Background Successfully recruiting respondents to complete surveys is integral for ensuring representative samples and providing adequate power for analyses that researchers can extrapolate to the population of interest. However, obtaining survey responses for public health and health services research can be challenging, especially when working with populations with varied engagement with the providers of the institution conducting the study. Recruitment is even more challenging when selecting participants based on historical events, which they may not remember, such as a brief health screen. Many researchers implement the Tailored Design Method (TDM) to optimize response rates. Methods We surveyed a national sample of 9,775 US Iraq and Afghanistan war veterans who had been screened between 2007 and 2018 for post-deployment health concerns in the Veterans Health Administration (VHA). We implemented a modified TDM to recruit respondents through USPS mail and an online data collection platform (i.e., Qualtrics) between July 2020 and August 2021. Results Twenty-one percent (N = 2,025) responded. It took a median of 21 and 69 days to receive responses via electronic survey (i.e., Qualtrics) and USPS, respectively. Participants had varied levels of engagement with the VHA at the time of screening and survey. Respondents and non-respondents used equal amounts of neurology, physical medicine and rehabilitation, and mental health VHA services in the 6 months post-screens. At the time of the survey, 20.82% of respondents reported not having recently used VHA services. Respondents were more likely to be older, White, and female than non-respondents, although differences were small in magnitude. Compared to online respondents, paper respondents were more likely to be older, rural, and screened earlier, and less likely to live in the same state as the research team. Conclusions This manuscript describes TDM implementation techniques and modifications that comply with federal regulations, and factors associated with response rates and contact methods. Researchers in federal institutions seeking to optimize response rates may find our TDM adaptations useful when surveying populations drawn from historical cohorts or without regular interaction with the research institution.

This commentary presents the five principles of a sustained efficiency model proven to be effective for partnering with operational and clinical partners in rigorous and rapid evaluations, utilizing a case study to demonstrate the efficacy of the model in use in a congressionally mandated Veterans Health Administration staffing evaluation initiative. The Veterans Affairs (VA) system faces increasing demands for timely, evidence-based decision making to enhance efficiency while maintaining high-quality care. To address these needs, the StrAtegic PoLicy EvIdence-Based Evaluation Center (SALIENT) developed a Sustained Efficiency Model grounded in implementation science and applied it in a congressionally mandated Specialty Care workforce evaluation. Our model integrates five interdependent principles: (1) proactive collaborative interdisciplinary partnerships that unite operational leaders, researchers, and stakeholders to enable rapid course corrections, (2) multi-level theoretical modeling that combines Lean Six Sigma, Human-Centered Design, and QUERI implementation frameworks to identify determinants of change, (3) systematic processes and strategies, as well as tailored applications and templates, (4) triangulating mixed-methods data and integrating diverse perspectives to enhance the rigor of analysis and offer real-time knowledge translation, and (5) progressive rapid iterative reporting to deliver timely findings to policy makers and congressional partners. The model's utility was demonstrated in the VA's SALIENT Staffing Project, which informed VA workforce guidelines required by the Honoring our PACT Act of 2022. Via close coordination with the Partnered Evidence-Based Policy Resource Center, the team collected and analyzed qualitative and quantitative data on an accelerated timeline, producing high-quality and relevant recommendations.

Background Respiratory syncytial virus (RSV) can cause severe illness, particularly in older adults, leading to thousands of hospitalizations and deaths annually among individuals aged 65 and older. In May 2023, the U.S. Food and Drug Administration (FDA) approved two vaccines, Arexvy® (RSVPreF3) and Abrysvo® (RSVpreF), for the prevention of RSV-related lower respiratory tract disease (LRTD) in adults aged 60 years and older. In May 2024, the FDA approved a third RSV vaccine, mRESVIA® (mRNA-1345). In June 2024, the Centers for Disease Control and Prevention (CDC) updated its guidance to recommend a single dose of an RSV vaccine for all adults aged 75 years and older, as well as those aged 60 to 74 years old with risk factors for severe disease. Clinical trials have demonstrated that all three vaccines are safe and effective in reducing RSV-related morbidity and mortality. Objective To review the literature describing the safety, efficacy, tolerability, and clinical application of RSV vaccines in older adults. Data Sources Primary literature identified through PubMed, the U.S. clinical trial registry, and CDC resources from 2021 to 2025, with an emphasis on randomized clinical trials and key studies supporting FDA approval. Data Synthesis Arexvy® (RSVPreF3), Abrysvo® (RSVpreF), and mRESVIA® (mRNA-1345) have demonstrated efficacy in reducing the risk of RSV-associated LRTD and severe RSV-associated LRTD in adults aged 60 years and older. Reported adverse effects include injection-site pain, myalgia, fatigue, and headaches. Economic analyses suggest that all three vaccines are potentially cost-effective. Conclusion RSV poses a significant risk of morbidity and mortality, especially in older adults. Arexvy® (RSVPreF3), Abrysvo® (RSVpreF), and mRESVIA® (mRNA-1345) have been shown to effectively prevent LRTD caused by RSV in individuals aged 60 and older. Pharmacists play a vital role in supporting CDC recommendations, educating patients and optimizing preventive health strategies.

BACKGROUND:Asymptomatic hyperuricemia is associated with poor outcomes in kidney and cardiovascular diseases, but its causative role remains controversial. Clinical studies have shown a positive correlation between increased dietary sodium intake and urinary uric acid excretion, suggesting that hyperuricemia may influence salt-sensitive hypertension and associated kidney damage.METHODS:To study the effects of mild hyperuricemia on salt-sensitive hypertension, male and female Dahl SS rats were fed a diet containing a uricase inhibitor (2% oxonic acid) and 4% NaCl (high salt) or a high salt-only diet for 3 weeks. Analyses were conducted using radiotelemetry, immunohistochemistry, and RNA-Sequencing.RESULTS:Uricase inhibition resulted in a ≈3.5-fold increase in plasma uric acid levels in both sexes compared with their respective high salt controls. However, only the male high salt/oxonic acid group exhibited a significant increase in uric acid excretion. The mild hyperuricemia significantly attenuated the progression of hypertension in male but not female rats. The male high salt/oxonic acid group showed reduced kidney hypertrophy and protein cast formation, indicating mitigated kidney damage. Supplementation with oxonic acid reduced oxidative damage in the tubules, as evidenced by the decreased fluorescence intensity of 8-oxodG. RNA-Sequencing analyses of male kidneys revealed that oxonic acid administration was associated with increased expression of genes linked to the activation of various vasodilatory pathways.CONCLUSIONS:Our study demonstrates that in male, but not female, Dahl salt-sensitive rats, mild hyperuricemia accompanied by hyperuricosuria slowed the progression of salt-sensitive hypertension, potentially due to reduced kidney damage.