{"title":"Suspected Orbital Compartment Syndrome Leading to Visual Loss After Pterional Craniotomy","authors":"Niketu Patel","doi":"10.12788/fp.493","DOIUrl":"https://doi.org/10.12788/fp.493","url":null,"abstract":"","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"84 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: No clear parameters currently exist to grade severity in restrictive lung disease as for other ventilatory diseases. This article evaluates whether total lung capacity (TLC) or forced expiratory volume in 1 second (FEV 1 ) better correlates with the symptomatology of patients with restrictive lung disease. Methods: A retrospective review of 6461 patient records at Veterans Affairs Caribbean Healthcare System in Puerto Rico was conducted, and 414 patients met the inclusion criteria. Pulmonary function test, Modified Medical Research Council Dyspnea Scale, FEV 1 , and TLC data were collected for each patient. Results: We identified a stronger correlation between FEV 1 ( r = 0.25, P < .001) vs TLC ( r = 0.15, P < .001) when related to the degree of dyspnea as measured with the Modified Medical Research Council Dyspnea Scale. Conclusions: Results of this study suggest that compared with TLC, FEV 1 may provide a more accurate measure of restrictive lung disease severity. Further research should look for more accurate measures of patient dyspnea in restrictive lung disease.
背景：与其他通气疾病一样，目前尚无明确的参数可对限制性肺疾病的严重程度进行分级。本文评估了总肺活量（TLC）或一秒钟用力呼气容积（FEV 1）是否与限制性肺疾病患者的症状有更好的相关性。研究方法对波多黎各退伍军人事务加勒比医疗保健系统的 6461 份病历进行了回顾性审查，414 名患者符合纳入标准。收集了每位患者的肺功能测试、改良医学研究委员会呼吸困难量表、FEV 1 和 TLC 数据。结果：我们发现，FEV 1 ( r = 0.25, P < .001) 与 TLC ( r = 0.15, P < .001) 与改良医学研究委员会呼吸困难量表（Modified Medical Research Council Dyspnea Scale）测量的呼吸困难程度之间存在更强的相关性。结论：本研究结果表明，与 TLC 相比，FEV 1 可以更准确地测量限制性肺病的严重程度。进一步的研究应寻找限制性肺病患者呼吸困难的更准确测量方法。
{"title":"Measuring Restrictive Lung Disease Severity Using FEV1 vs TLC","authors":"Rebeca Vazquez-Nieves","doi":"10.12788/fp.0481","DOIUrl":"https://doi.org/10.12788/fp.0481","url":null,"abstract":"Background: No clear parameters currently exist to grade severity in restrictive lung disease as for other ventilatory diseases. This article evaluates whether total lung capacity (TLC) or forced expiratory volume in 1 second (FEV 1 ) better correlates with the symptomatology of patients with restrictive lung disease. Methods: A retrospective review of 6461 patient records at Veterans Affairs Caribbean Healthcare System in Puerto Rico was conducted, and 414 patients met the inclusion criteria. Pulmonary function test, Modified Medical Research Council Dyspnea Scale, FEV 1 , and TLC data were collected for each patient. Results: We identified a stronger correlation between FEV 1 ( r = 0.25, P < .001) vs TLC ( r = 0.15, P < .001) when related to the degree of dyspnea as measured with the Modified Medical Research Council Dyspnea Scale. Conclusions: Results of this study suggest that compared with TLC, FEV 1 may provide a more accurate measure of restrictive lung disease severity. Further research should look for more accurate measures of patient dyspnea in restrictive lung disease.","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"62 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Act Fast With Traction Alopecia to Avoid Permanent Hair Loss","authors":"Kayla Felix Taylor","doi":"10.12788/fp.0505","DOIUrl":"https://doi.org/10.12788/fp.0505","url":null,"abstract":"","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Overweight and obesity are common in the veteran population. Medical management with semaglutide, orlistat, liraglutide, phentermine, phentermine/topiramate, and naltrexone/bupropion is increasingly common. This study expands on a 2021 study and evaluates medication effectiveness. Methods: This single-center retrospective study analyzed patients prescribed weight loss medications at Veteran Health Indiana. Primary outcomes included body weight loss and total weight loss with each medication at 3, 6, 12, 24, 36, and 48 months. Secondary outcomes were also used to determine the efficacy of the current weight loss medications. Results: Of 105 included patients, 66 were treated with liraglutide, 30 with phentermine/topiramate, 5 with naltrexone/ bupropion, 3 with orlistat, and 1 with phentermine. The absolute weight loss for all medications was 10.6 kg over the patient-specific duration of weight management therapy. The mean body weight loss was 9.2%. There were no statistically significant differences in primary or secondary outcomes between liraglutide and phentermine/topiramate. The group sizes were too small to analyze the other medication groups. Conclusions: Patients in this study lost weight while using medications. However, there were no statistically significant differences among the medications. Patients did not receive uniformly consistent follow-up care, suggesting the need for more standardized processes that could lead to better weight loss outcomes.
{"title":"Long-Term Assessment of Weight Loss Medications in a Veteran Population","authors":"Allison Rodriguez","doi":"10.12788/fp.0490","DOIUrl":"https://doi.org/10.12788/fp.0490","url":null,"abstract":"Background: Overweight and obesity are common in the veteran population. Medical management with semaglutide, orlistat, liraglutide, phentermine, phentermine/topiramate, and naltrexone/bupropion is increasingly common. This study expands on a 2021 study and evaluates medication effectiveness. Methods: This single-center retrospective study analyzed patients prescribed weight loss medications at Veteran Health Indiana. Primary outcomes included body weight loss and total weight loss with each medication at 3, 6, 12, 24, 36, and 48 months. Secondary outcomes were also used to determine the efficacy of the current weight loss medications. Results: Of 105 included patients, 66 were treated with liraglutide, 30 with phentermine/topiramate, 5 with naltrexone/ bupropion, 3 with orlistat, and 1 with phentermine. The absolute weight loss for all medications was 10.6 kg over the patient-specific duration of weight management therapy. The mean body weight loss was 9.2%. There were no statistically significant differences in primary or secondary outcomes between liraglutide and phentermine/topiramate. The group sizes were too small to analyze the other medication groups. Conclusions: Patients in this study lost weight while using medications. However, there were no statistically significant differences among the medications. Patients did not receive uniformly consistent follow-up care, suggesting the need for more standardized processes that could lead to better weight loss outcomes.","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"8 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: High reliability organizations are designed to operate under complex conditions for extended periods by strengthening systems that help serious adverse events for patients. The US Department of Veterans Affairs formally began its enterprise-wide journey to high reliability in 2019. Four foundational practices were identified to advance a culture of safety across all Veterans Health Administration facilities. This article describes these practices, summarizes supporting evidence from the literature, and illustrates strong practices for improving safety. Observations: A literature review was conducted from 2018 to March 2023 to identify recent evidence outlining the value of implementing the 4 foundational high reliability organization practices to improve patient safety. This evidence was used to create and implement formal processes for the foundational practices. For each foundational practice, a representative example of a strong practice within the Veterans Health Administration is provided. Conclusions: Effective and sustained application of the foundational organization practices described can support a health care organization’s journey to high reliability. Collectively, the 4 foundational practices can be adopted and implemented by other organizations in the continued pursuit of high reliability in health care.
{"title":"The Role of High Reliability Organization Foundational Practices in Building a Culture of Safety","authors":"John Murray","doi":"10.12788/fp.0486","DOIUrl":"https://doi.org/10.12788/fp.0486","url":null,"abstract":"Background: High reliability organizations are designed to operate under complex conditions for extended periods by strengthening systems that help serious adverse events for patients. The US Department of Veterans Affairs formally began its enterprise-wide journey to high reliability in 2019. Four foundational practices were identified to advance a culture of safety across all Veterans Health Administration facilities. This article describes these practices, summarizes supporting evidence from the literature, and illustrates strong practices for improving safety. Observations: A literature review was conducted from 2018 to March 2023 to identify recent evidence outlining the value of implementing the 4 foundational high reliability organization practices to improve patient safety. This evidence was used to create and implement formal processes for the foundational practices. For each foundational practice, a representative example of a strong practice within the Veterans Health Administration is provided. Conclusions: Effective and sustained application of the foundational organization practices described can support a health care organization’s journey to high reliability. Collectively, the 4 foundational practices can be adopted and implemented by other organizations in the continued pursuit of high reliability in health care.","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"137 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Challenges of Delivering Allergen Immunotherapy in the Military Health System","authors":"Christopher Coop","doi":"10.12788/0487","DOIUrl":"https://doi.org/10.12788/0487","url":null,"abstract":"","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"49 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Use of Hypoglossal Nerve Stimulation for Treating OSA in Military Patient Populations","authors":"Jessica Alford","doi":"10.12788/0480","DOIUrl":"https://doi.org/10.12788/0480","url":null,"abstract":"Background","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"172 S390","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The Olin E. Teague Veterans’ Center (OETVC) is a teaching hospital with a medical ward consisting of 189 beds, 3 teaching teams with 1 resident and 2 to 3 interns, and 3 nonteaching teams. Due to the complexity of hospitalization, there are concerns that patients may not follow up with primary care or fill their prescribed medication and may have postdischarge questions. Observations: A program was created at OETVC to bridge the gap between inpatient and outpatient care. Internal medicine residents call all teaching team patients a week following discharge. They discuss medications, changes in symptoms, follow-up plans, and address all questions. The residents also assist with missed orders and make treatment regimen changes if necessary. Conclusions: This new program has proven to be beneficial. Residents are developing a better understanding of illness scripts and are working on communication skills without time constraints. Patients now have access to a physician following discharge to discuss any concerns with their hospitalization, present condition, and follow-up. Data show a decreased 30-day readmission rate at 6% in the transition of care group compared to 10% in all patients who participated in the program. This program will continue to address barriers to care and adapt to improve the success of care transitions.
{"title":"Bridging the Gap Between Inpatient and Outpatient Care","authors":"Nikhil Seth","doi":"10.12788/0476","DOIUrl":"https://doi.org/10.12788/0476","url":null,"abstract":"Background: The Olin E. Teague Veterans’ Center (OETVC) is a teaching hospital with a medical ward consisting of 189 beds, 3 teaching teams with 1 resident and 2 to 3 interns, and 3 nonteaching teams. Due to the complexity of hospitalization, there are concerns that patients may not follow up with primary care or fill their prescribed medication and may have postdischarge questions. Observations: A program was created at OETVC to bridge the gap between inpatient and outpatient care. Internal medicine residents call all teaching team patients a week following discharge. They discuss medications, changes in symptoms, follow-up plans, and address all questions. The residents also assist with missed orders and make treatment regimen changes if necessary. Conclusions: This new program has proven to be beneficial. Residents are developing a better understanding of illness scripts and are working on communication skills without time constraints. Patients now have access to a physician following discharge to discuss any concerns with their hospitalization, present condition, and follow-up. Data show a decreased 30-day readmission rate at 6% in the transition of care group compared to 10% in all patients who participated in the program. This program will continue to address barriers to care and adapt to improve the success of care transitions.","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"88 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The COVID-19 pandemic, combined with the shortage of nursing staff, contributed to higher levels of stress. Sustained stress has been associated with burnout. However, nurses have traditionally demonstrated resourcefulness skills that resulted in building resilience. Observations: This pilot project recruited US Department of Veterans (VA) registered and advanced practice nurses to participate in a resourcefulness skills training initiative. VA nurses were found to have a moderate level of burnout at baseline. Nurses participated in Resourcefulness Training to handle stress and possible burnout. Resourcefulness Training themes included accessing family and peer support, developing organizational and problem-solving skills, and using distraction. Conclusions: Nurses must be vigilant in appraising and managing their ability to cope and adapt to individual stress, while also being aware of their colleagues' stress levels. Educational institutions, professional organizations, and health care facilities must strive to educate and support nurses in identifying stress and healthy coping mechanisms. In this project, relying on family and peers emerged as an important resourcefulness skill.
{"title":"Evaluation of a Stress, Coping, and Resourcefulness Program for VA Nurses During the COVID-19 Pandemic","authors":"Denise Kresevic","doi":"10.12788/fp.0478","DOIUrl":"https://doi.org/10.12788/fp.0478","url":null,"abstract":"Background: The COVID-19 pandemic, combined with the shortage of nursing staff, contributed to higher levels of stress. Sustained stress has been associated with burnout. However, nurses have traditionally demonstrated resourcefulness skills that resulted in building resilience. Observations: This pilot project recruited US Department of Veterans (VA) registered and advanced practice nurses to participate in a resourcefulness skills training initiative. VA nurses were found to have a moderate level of burnout at baseline. Nurses participated in Resourcefulness Training to handle stress and possible burnout. Resourcefulness Training themes included accessing family and peer support, developing organizational and problem-solving skills, and using distraction. Conclusions: Nurses must be vigilant in appraising and managing their ability to cope and adapt to individual stress, while also being aware of their colleagues' stress levels. Educational institutions, professional organizations, and health care facilities must strive to educate and support nurses in identifying stress and healthy coping mechanisms. In this project, relying on family and peers emerged as an important resourcefulness skill.","PeriodicalId":513268,"journal":{"name":"Federal Practitioner","volume":"8 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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