Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献

Background: The Epilepsy Centers of Excellence (ECoE) is a network of facilities within the Veterans Health Administration that evaluates and treats veterans with epilepsy and seizure disorders. This article outlines how the COVID-19 pandemic impacted ECoE services and recovery.

Methods: Directors of 17 ECoEs were surveyed 4 times between May 2020 and July 2022 on 5 domains: functioning of outpatient epilepsy clinics, outpatient electroencephalogram, epilepsy monitoring unit, anticipated permanent operational changes, and utility of national and local recommendations. Data on the spread of COVID-19 and administrative workload data were compared with the availability of epilepsy services.

Results: There was an increase in in-person outpatient visits from May 2020 (1 of 13 sites) to June 2022 (all 16 sites). Similar increases were also observed for outpatient electroencephalogram from 4 of 13 sites and subsequently all 16 sites, and for epilepsy monitoring unit from 1 of 12 sites to 11 of 16 sites. The spread of COVID-19 did not correlate with the availability of services. Respondents predicted telehealth would be a permanent change.

Conclusions: Comprehensive ECoEs within the Veterans Health Administration increased services during the COVID-19 pandemic without demonstrating an association to the disease's spread.

Background: Patients with diabetes have traditionally been required to use fingerstick testing to self-monitor their glucose levels. However, continuous glucose monitors (CGMs) collect glucose readings throughout the day and display daily trends, which allow clinicians to individualize treatment to achieve hemoglobin A_1c (HbA_1c) goals and simplify medication regimens. While studies have shown that CGMs improve HbA_1c levels compared to fingerstick testing, this research has focused on type 1 diabetes and excluded veterans and patients on insulin therapy.

Methods: This retrospective chart review used a crossover, self-controlled design conducted at the Veterans Affairs Sioux Falls Health Care System. Veterans with an active CGM prescription were included. The primary endpoint compared the change in HbA_1c before and after initiation of a CGM.

Results: The mean baseline HbA_1c for the 150 veterans included in this study was 8.6%. The change in HbA_1c before CGM use was 0.003 and change in HbA_1c after CGM use was -0.971. The primary endpoint of difference in HbA_1c associated with CGM use was -0.969 (P = .0001). The overall mean change in total daily doses of insulin was -22 units. Subgroup analysis of change in HbA_1c after CGM use by prescriber type was -0.97 for endocrinology, -0.7 for pharmacy, and -1.23 for primary care practitioners. The overall average HbA_1c post-CGM use was similar across all prescriber types at 7.64%.

Conclusions: This study found veterans with type 2 diabetes and on insulin therapy demonstrated a significant reduction in HbA_1c with CGM use compared with their baseline fingerstick monitoring. Use of a CGM may be beneficial in patients who require a reduction in HbA_1c by allowing more precise adjustments to medications to optimize therapy.

Background: Guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal of < 70 mg/dL for patients with very high-risk atherosclerotic cardiovascular disease (ASCVD). While alirocumab monotherapy and ezetimibe plus statin therapy have both shown efficacy in independently reducing LDL-C, a direct comparison has not been conducted.

Methods: A retrospective chart review at the Veterans Affairs Sioux Falls Health Care System compared 20 patients with a history of ASCVD events who received alirocumab monotherapy to 60 patients receiving ezetimibe plus statin therapy. The primary endpoint was incidence of reaching the < 70 mg/dL LDL-C goal after 4 to 12 weeks, 13 to 24 weeks, and 25 to 52 weeks.

Results: Fourteen patients (70%) in the alirocumab monotherapy group reached the LDL-C goal (< 70 mg/dL) compared with 34 patients (57%) in the ezetimibe plus statin group (P = .29). In both groups, the goal was most frequently achieved in 25 to 52 weeks.

Conclusions: In a small population of veterans with ASCVD, there was no significant difference between the 2 treatment groups in LDL-C reduction or in several secondary endpoints, including percentage change in high-density lipoprotein and triglycerides, ASCVD events, and adverse events leading to treatment discontinuation. However, a statistically significant difference in percentage reduction in LDL-C and total cholesterol was found favoring alirocumab monotherapy.